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<br />fIIev 1/94
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<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />200604621
<br />
<br />1~NT -NAM~~~"
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />lAST
<br />
<br />!;~"~_~:---'T . (~~; O;A;', 'Mi'~;; ,.."
<br />
<br />uNoE:.H 1 O:=IY 6 DA1EOF B1HrH IMmm, O.IY r{l~r)
<br />'0 H(1lJRS M"'S J u 1 y 6, ) 91 2
<br />
<br />----------- ---
<br />
<br />Ruth
<br />
<br />Augusta Wilhemina
<br />
<br />Stolle
<br />
<br />" CITY ANOS1Alr Of. Blf=l'lH (lfflotinUSA..
<br />
<br />";: b;:s k~:I~~,_L~~B;~~ 5~~~~ 1 Y~:~~--
<br />
<br />eo. PLACE or DEA H'
<br />
<br />Merrick County,
<br />
<br />TSciCif;L"SECUR'i,y NUMum----
<br />
<br />
<br />8bfACTliTY":'-N'am~"'-"~."-_._"._'_._"- {If nor In,<;,lIwtion. give slrep.1 flnri rllJmber}
<br />Tiffany Square Care Center
<br />
<br />HOSPITAL 0 Inpatient OTHET~ 0 Nll!':";Ir'IQ 11rnl\('
<br /> 0 FR Outpiitip.nl 0 R~!>ldF'rjr:f!
<br /> 0 aOA 0 Olher I :=;Jl~'!'" d~ I
<br />
<br />.
<br />
<br />506-40-2452
<br />
<br />Island
<br />
<br />
<br />9("/ STm::FT AND NUMBfn
<br />
<br />(lndtJd1ng 7/r r7orlp!
<br />
<br />rj~''''iN"sii)( cil"'y i iMj"I"2:
<br />
<br />Grand
<br />
<br />Island
<br />
<br />_..--..-,....---,.~.---]8d INSIDE CITV LIMITS
<br />
<br />Yo, [K] No 0
<br />g,. 6fy.'TOWN'OOLOCA'i'ON ------
<br />
<br />CQIJNTY Or-:"tl'EAT'H
<br />
<br />TcCiTTT6WN-QiiLoCATiOiToF'6fA TH
<br />
<br />
<br />90. RE:;~:::~~a ----I:_~;:;~l
<br />
<br />10. RACE (e.g., Whilp., Rlilr.k American Indian lU'NCESTRY (e Q . IIRlia,rl, Mel(lcar"l, Gerrnat\:-;t~-
<br />e'c,IIS~Clfyl fSpPclfyl
<br />White American
<br />
<br />1~0 uSuAL oCCUPAfI()N ,G,;;;.-;;,d01 WOI. done dunngmosl .._--,-.r14b"'K~-.'.N._.~~D,sOFtOaUSu'NErSaS 'nNDtUSTnBYtlS ine s s
<br />of W(I/"klfUJ 'if~. p.1I('n if retlredl
<br />Owner/Operator
<br />.16:TAiHEii:.NAME.'.'-...-----.--FIRST MIPpiT LAST 17 MOl HeR
<br />
<br />Grand
<br />
<br />68801
<br />
<br />v., RrJ No D
<br />
<br />11 NAMF. OF spousr (If wrfp QIV~ 111,11(1('11 1l,Jr11r:'}
<br />
<br /> ai
<br /> t::
<br /> 0
<br /> (;
<br /> U
<br /> >-
<br /> C
<br /> ::I
<br /> 0 .
<br /> U
<br /> (; .
<br /> (j;
<br /> t::
<br /> E
<br /> '"
<br /> ><
<br /> III
<br /> (ij
<br /> u
<br />I- '0
<br />Z III
<br />W E
<br />0 c:
<br />ill '"
<br />U U
<br />ill iii
<br />>-
<br />0 .L:
<br />LL C.
<br />>-
<br />0 D
<br />ill III
<br />III
<br />::2: ::l
<br /><{ (;
<br />Z u.
<br />M
<br />M
<br />
<br />Arthur
<br />
<br />Stolle -deceased
<br />
<br />)_. __ um _________ ________
<br />1"i E-DlJCA 'ION (s.,~( lly only tllgl1eSt gr8dp c.;OfT1l1leledl
<br />-~~~. ----
<br />Elem0l11iV6' Scconrl~!v jO 1?) C~i?:::":"~ 01 !l'l
<br />
<br />rlRsr ~ - ~~ MIODlE MAII.JH; ~UAN^ME
<br />
<br />Oscar Paul Scherzberg
<br />
<br />18 WAS DECEAsEfj-'EvERiNijs-"ARMm F(1RCES? -~-I'9' INFORMANT NAMF
<br />(Yes ~': or unk.) I flf YP.!'i lj'IVe wat an:::! dalos 01 SOrvlC8Sj
<br />tj~____ Bob Schwie~=E___"
<br />
<br />19tJ IN~O~"ANT MAli ING APPR;:;;-- ISfHEEl OR RrD NO.. CIlY OR TOWN. STATF 7IPI
<br />
<br />20 F ~A~~:~I~~l:iIC;N~FrN~et, St. :aUl, ~~~~:O~~:'OS"'~"~~'~?P^TF----"-
<br />_~__e:_~d:f.. 1/43 []low,., On.."",", .June ~, ._1.~.95
<br />
<br />r tJNEHAl HOME: NAME 21d CE.M[:l EJ-lY"On i~nFMA relRY LOCA lION
<br />
<br />Anna
<br />
<br />Marie
<br />
<br />Elstermeier
<br />
<br />-'~l ;...' c;F"MF YFnv nnTilFMfiI("")"Ry".'"Ni\Mf
<br />
<br />
<br />Westlawn Memorial Park
<br />
<br />(3;ry"(JriT()~-----~.'''si'^tf''
<br />
<br />Livingston-Sondermann F.H.
<br />
<br />o Crp.l'I1l\liori 0 D(lflaMn
<br />
<br />Grand Island, Nebraska
<br />
<br />FUNERAL HOME: AIJDI4~:SS
<br />
<br />iSTRFF! OR R.F P NO ''''V OR lOWN.SI^1E'ZIPI"._.~~-
<br />
<br />505 West Koenig,
<br />n ~rMM"""ffiiATFCA\j~'--'
<br />PA,RT
<br />
<br />'~ "
<br />~~J!L_ fJL:.l1l11:2J1~_________
<br />nUE T OR AS A CONSFOUF-NC[ or
<br />
<br />Grand Island, Nebraska 68801
<br />--'.'_U"'.'-""""j"ENTER ONLY ONE CAUSf:: PWINE ron"'"(;llhl.-AND (..)I n_.....
<br />
<br />I ,. ""~"I;:;i~~~~i'h;I;-~~-;~~;~' ;;-,~';i ;j,:;,H>
<br />:.l!___d~l 1/..2_.. -
<br />I Inlpr\iClI hf!~;n OIlS~:' ,If)d 11;',1111
<br />I
<br />I
<br />
<br />{bl
<br />--oUE TO. OR AS A CONSEOUFNCf Of
<br />
<br />----_._.__.....,--".,.,~,.. .'.
<br />IntCllI[l1 hlllwCpn on~,f!! ,'Ind dP;llh
<br />
<br />~._-~_.~
<br />21~ O^ TE Of OEA TH (Mn DilV Yr.J
<br />
<br />
<br />I
<br />I
<br />__,I" ~~".,.~~~",..._______.___.,__
<br />]JARl ~! If r[MALE WAS THFI1E A j 25 WAS CAS!: ~.lH[Rn[f.J 10 M.. .1.,~DIC^t"
<br />PREGNANCY IN THf PARI ::\ M()N rtiS? [XAMINfTl on conONr:n"'
<br />
<br />IAge,. 10 541 Ve, No K,e, No ibd.,L____.!~__il._":'_.Jxk
<br />
<br />
<br />HOUR OF IN,J"I~:_J:~::r:': '~:~ '~JI "'~_~'~JHflfD _____ _ _ .______________
<br />
<br />~k~~~u7ldj~".J~~y i~~7Yr' hum, !ilr~!el.laclory 269 lOC^TION SlREET on R r,D" NO CITY OR I()WN Sl^ I!
<br />
<br />lei
<br />l='~~~v6nIER SIGNIfiCANT CONOtTlON5 - Condil!ons conlrlblJlirlg 10 Ih@ dealh but not rel!'l'~d
<br />
<br />"
<br />
<br /> -"._-,---"~--"-"'-" -,-----
<br />~"o ~b DA IE OF INJURv
<br />0 AC(;Ident 0 lJndelermlned
<br />0 Suicide 0 P~n("hnq 26Q INJURY AT WORK
<br />0 Homicide Irlvp.!:i11qr.liol'l YosO NOO
<br />
<br />2aa ()A TE SIGNI:D (Mo n.=W y,)
<br />
<br />28b T1Mf or DEATH
<br />
<br />,=--~ ~
<br />~ ~ Z 78c PRONOUNCf.D bEAD (Mo, D.1Y, y"
<br />ii~~~
<br />" h~~
<br />____--L1-:..05 8 Z <5 ._.~------..----.-'"."--.-
<br />~7d 10 mE'! tJe~t 01 my kr'(1wlcC1qe ~e th OCcuHF!d at lhl'! lime d<'lle "net pli'lf':p. <tnd dtJ~ In 11Ip. I? ~ u 7RP. Of1lhe basIs of C'ill\tntnJllon (Inn Qf lnvp.!'ihq<lllori In my
<br /> Or"ltl'Orl dealh /)f.CllrrP.fl ill
<br />'f cau~orsl ~Mled a ---..........- ~....... A./ 1 8 0 lhe lime date and plRCP. ami r1up. 10 Ihe cau~Nsl staled
<br />l~~~~~!:. ~ _~L:J..1 D _ ISIQnaIUrE! aO(t TIlle'"
<br />~9 0.1) tDC::~SE CO~u N:T 30. HAS~OH D"Ev:~NATI(1Ni~r::NSIOEHU" _n..C~-WASC(;"NSi:Nn"Av:~[J';EJ NO
<br />
<br />3. NA"E AND ~DDRESS or CERTlFlfR (pHVSICIAN. CORONERS PHYSICIAN OR COUNTY A HORNEYI ITvpe -;';'P;;,;ij
<br />
<br />)( t1~Y_12.L...J 995
<br />~7b I.)ATF. SIGN~O (Mo, Oily Vr!
<br />
<br />it
<br />~ I..
<br />u ~o
<br />~ ~
<br />>. ~
<br />
<br />~?c TIME or DEATH
<br />
<br />?8c1 PRONOllNU,O O[AD (Hood
<br />
<br />~______..M
<br />
<br />'1-,1 IJJ!g2.......- I 9 9 5
<br />
<br />"
<br />
<br />"
<br />
<br />~ Thomas F. We~E~r, M.D.
<br />32. REGISTRAR
<br />
<br />2444 ~_.X~~.~.l~L_
<br />
<br />Grand island, NE 68803
<br />----r2b DA1EFlLEDBVREGIsmAR (MoOav YI.)
<br />
<br />FOR VITAL STATISTICS USE ONLY
<br />
<br />nn..................C................
<br />
<br />nn'O ..............................nE nnn.n.......................Parl 11.-,
<br />
<br />n.nTMV..........
<br />. Census Tract No,
<br />
<br />Place .......................A n..............................8 .......,
<br />
<br />NSC .......................,..,........ u.................................,...
<br />
<br />Work.........................,........,.......................................
<br />
<br />UC......,..................,..,..""'.n._..........,..,....,..........."...-
<br />
<br />Reject ................... ... ......, .......,........... ................... ....,."
<br />
<br />C 'rli1tedl -""" toY I:\k ." feCr~ p.pM 4\
<br />
<br />
<br />Z.")
<br />
<br />Q. l:k'.):.f~;n:.i filed Wlll the
<br />
<br />r~..;'I'"'~.n""',:i,:..-.."""'t'-~'W'~.w.-~~~...:t;!!.~~j
<br />:; ::t GEr:rEnAl .1tO. T.,q. WI.S. t3W 1)f. ~r.bf?-ska 11.
<br />!, rl~'" n"',f~IIT':~ r"" r-,l(l,r~t'f'i!("'l. _H
<br />. . .;", , . "fK:l,!ltJ:
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