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<br />
<br />~ ,. -
<br />'WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STA'IiDEPAiffMENT OF HEAL TH,
<br />"CERTIFIES THE BELOW TO BE A TRUE COpy OF AN ORIGINAL ~0R6-0N FiiiwiiK THE STATE
<br />DEPARTMENT OF HEAL TH, BUREAU OF V"AL STA TIS TICS, wHJJ;ff-i~_ t~J,EfI~Dip(i'&!IORY FOR
<br />
<br />:::::::~CE {!-.'i!::
<br />
<br />JUL 1 0 1996 20060 467 G -,e_",- -. ASslSTANTftATE~GISTRAR
<br />LINCOLN, NEBRASKA NEMAS/fA-DEP/fRJMENj;VF HEAL TH
<br />STATE OF NEBRASKA - DEPARTMENT OFHEALTH='-
<br />BUREAU OF VITAL STATISTICS ~ --
<br />CERTIFICATE OF DEATH
<br />
<br />,. DECEDENT. NAME
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />LAST
<br />
<br />2. SEX
<br />
<br />J. DATE Of DEATH '__Oay. YOO1J
<br />
<br />70
<br />
<br />UNDER' YEAR
<br />50. MOS. I DAYS
<br />I
<br />
<br />Male
<br />
<br />UNDER , DAY
<br />5c. HOURS I MINS
<br />
<br />June 26, 1996
<br />
<br />Richard
<br />
<br />Neil
<br />
<br />Launer
<br />
<br />4. CITY AND STATE OF BIRTH {NnoIi> u.s.A. """,. countryl
<br />
<br />50. AGE - Last Binhdav
<br />(Yrs.l
<br />
<br />6_ DATE OF BIRTH {__ Day. Y..rl
<br />
<br />Columbus, Nebraska
<br />7, SOCIAL SECURTIY NUMBER
<br />
<br />August 21, 1925
<br />
<br />507-16-8991
<br />8t>. FACILITY - N.",.
<br />
<br />(If not Institution, give street and numtJet)
<br />
<br />60. PLACE OF DEATH
<br />HOSPITAL: [!J InpatMn OTHER 0 Nursing Home
<br /> 0 ER 0utpa\i8f1t D Residence
<br /> 0 DOA 0 0Il1e' {Speedyl
<br />
<br />St. Francis Medical Center
<br />6C CITY TOWN OR LOCATION OF DEATH
<br />
<br />German
<br />
<br />
<br />Hall County
<br />9d. STREET AND NUMBER {Incl'-'Cfinl} Zip c_,
<br />
<br />.. INSIDE CITY LIMITS
<br />
<br />8<1. INSIDE CITY LIMITS 8e COUNTY OF DEATH
<br />
<br />Grand Island
<br />9._ RESIDENCE - STATE
<br />
<br />Nebraska
<br />
<br />
<br />68801
<br />
<br />Y..@ NO 0
<br />
<br />10. RACE. (e.g., White, 61.ac:k. American hcIi.an.
<br />
<br />8lc.IIS00<ifyl Whi te
<br />
<br />'4a. USUAl OCCUPATION {Give.lntloI"",,' doned<ri>g mos/
<br />I oIworlIingld8, ..."d_1
<br />Tech.
<br />
<br />11. ANCESTRY le.gnltalian. Mejl;Ican. German. EltC:j
<br />
<br />, J NAME Of SPOUSE {N wife. give maidan ""mel
<br />
<br />'SpocllyJ
<br />
<br />Doris Schulte
<br />
<br />15. EDUCATION (Specify only
<br />Heating & Air Conditioni gE~~~~a~~~
<br />
<br />Qf_e~1
<br />CoKege 11-4 Of ~"'I
<br />
<br />FIRST
<br />
<br />LAST
<br />
<br />
<br />Louise
<br />
<br />NMI
<br />
<br />Johannes
<br />
<br />( Dec. )
<br />
<br />i 16_ FATHER. NAME
<br />
<br />MIDDLE
<br />
<br />17. MOTHER
<br />
<br />MIDDLE
<br />
<br />MAIDEN SURNAME
<br />
<br />Jacob G. Launer
<br />-18. WAS DECEASED EVER IN U_S_ ARMED FORCES?
<br />(Yes. 00. or unk.) flf ~s. give war and csare~ 01 S4tfViceS1
<br />Yes Nov. 1943-Nov.
<br />, 90. INFORMANT MAILING ADDRESS
<br />
<br />( Dec. )
<br />WWII
<br />1946
<br />
<br />Doris Launer
<br />
<br />ISTREET OR AF.D NO., CITY OR TOWN, ST ATE_ ZlPI
<br />
<br />1420 W.
<br />
<br />Island, Nebraska 68801
<br />21. METHOD OF DISPOSITION 2' ~_ DATE
<br />
<br />21e. CEMETERY OR CREUATORY - NAME
<br />
<br />
<br />[] Eiu"a1 D ""mo"al June 29, 1996 Westlawn Memorial Park Cemet
<br />
<br />21 d. CEMETERY OR CREMATORY LOCATION
<br />
<br />CITY OR TOWN
<br />
<br />STATE
<br />
<br />Kleine Funeral Home
<br />
<br />o ~ 0 Donat"",
<br />
<br />Grand Island, Nebraska
<br />
<br />22b. FUNERAL HOME ADDRESS
<br />
<br />lSTREET OR R_F_D_ NO__ CITY OR TOWN_ STATE. ZIP)
<br />
<br />3213 W. North Front St., Grand Island, Nebraska 68803
<br />_ 'ENTER ONLY ONE CAUSE PER LINE FOR 1.1, '~I. AND (ell
<br />\t\ \\1..).. r(
<br />
<br />Interval between onset and death
<br />
<br />11
<br />41
<br />:J
<br />
<br />
<br />Interval between (In$8t and death
<br />
<br />ft'MfV31 between onset ano (tf'!'alh
<br />
<br />o Acc'den1 D Unoeterminec;l
<br />D Suicide 0 Pending 26e. INJURY AT WORK
<br />o Homicide Investigation Yes D No D
<br />
<br />M
<br />261. ~~&..q;i~J:;:~Y (~~' fatm. street. faeb'y
<br />
<br />
<br />lei
<br />PART OTHER SIGNIFICANT CONDITIONS - Co<>dibon. eOfltfibulir>g '" \he "".", buI "'" ,.I.ted
<br />
<br />"
<br />
<br />26a
<br />
<br />26~_ DATE Of INUURY {Mo., Oay, Y'J 26C HOUR OF INJURY
<br />
<br />2611. LOCATION
<br />
<br />STREET OR R.F.D. NO.
<br />
<br />CITY OR TOWN
<br />
<br />STATE:
<br />
<br />~Ili~
<br />- ~>-
<br />:l!P
<br />- e!
<br />i ~
<br />J
<br />
<br />
<br />{Mo. Oay, Y'-J
<br />
<br />C. -
<br />
<br />260. DATE SIGNED (Mo, Day. yo
<br />
<br />28t>. TIME OF DEATH
<br />
<br />!...
<br />
<br />1~
<br />
<br />f7
<br />due~
<br />
<br />>-~ t.
<br />~l;lz
<br />h~~
<br />h~~
<br />~n
<br />
<br />M
<br />
<br />28<:. PRONOUNCED DEAD {Mo.. Oay. Yr.1
<br />
<br />2&1_ PRONOUNCED DEAD {Hoo'1
<br />
<br />M
<br />
<br />M
<br />
<br />28e. On tne ba.si~ of examination and/or investigation. in my opinion death occurred at
<br />!he time, date and place and due to the cause(51 staled.
<br />
<br />WAS CONSENT GRANTED? ....,..., ./"""
<br />DYES L:rNO
<br />
<br />3'
<br />
<br />(Typo or PnnII
<br />
<br />Kimberly
<br />32._ REGISTRAR
<br />
<br />Custer, Grand Island, NE 68803
<br />321> DATE FILED BY jUrR {MoB 0.1996
<br />
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