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<br /> _.______ __0.
<br />
<br />
<br />
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<br />
<br />,
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<br />
<br />STATE OF NEBRASKA
<br />
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH ANDHUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGIN~REC()BcifJti~E WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA1f1S'T1CSsii:;j1Q~H IS
<br />
<br />
<br />~;:::~~~i;~RYroR ~:LOR:OORD5s3 3 0 ~~~~:
<br />
<br />LINCOLN, NEBRASKA HEAbTH !Jm'!'J1!!lAN,cSEFI}$CES
<br />-
<br />....--- -
<br />
<br />G,fJ<I
<br />
<br />
<br />STATE OF NE'RASKA-DEPARTMENT Of HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH i.
<br />
<br />79
<br />
<br />08358
<br />
<br />'-~~
<br />
<br />DECEDENT -HAME
<br />
<br />FIIST
<br />
<br />I.
<br />
<br />Mar
<br />
<br />CITY AND STATE OF IIITH (111101 i.. U.S.A.,
<br />no.... ctJutt'" J
<br />8. llmore COUll
<br />SOCIAL SECUIITY NUMIEI
<br />
<br />Witt
<br />
<br />Adams
<br />
<br />Albert
<br />
<br />Yetman Lz
<br />INfOlUAANT - NAME -1If1.A TrON$HIP -lMllING ADDRESS
<br />
<br />Mary
<br />
<br />I' HaS'. O' '....51 Inll:t'l!:eI'" bOA.
<br />OUtpati.nt/E.... 1m.. Inpt;iti.nt (Specift1
<br />U.. Inpa ti en t
<br />INSIDE CITY Wo\lTS
<br />(SP.cYe!l or No)
<br />IS..
<br />LA
<br />BUI-uS
<br />
<br />MIDDLE
<br />
<br />150:.
<br />
<br />Doniphan
<br />LAST
<br />
<br />MIDDLE
<br />
<br />WAS DECEASED EVER IN U.S. AIMED FOICES?
<br />(....1. no. Ilk ~".) I (I' ,.to. ,9i~ wG, t and dill..... ot ,...,...ic:lR')
<br />
<br />11. ..._",,---
<br />IUIIAL. Cremotioll, R.movel DATE
<br />
<br />(SUUT OR "'.D. NO.. CITY OR TOWN. STAH. lIP)
<br />
<br />19. Hus : Charles R. Witt, Box 211, Doniphan, Nebr. 68832
<br />CEMETEIY 01 CIEIM TOIY - NAME LOCATION CITY 01 TOWN STATE
<br />
<br />
<br />20<.ParkV'iew Canetery
<br />FUNERAL HOME-NAME AND ADOIfSS
<br />
<br />:lCd. Hastings, Nebraska
<br />68901
<br />ton-Bv.tler-Volland Fmeral Heme, Hastings i Nebr.
<br />
<br />(STRut OR R.f.D. NO.. CITY OR TOWN. STAff. lIP)
<br />
<br />OR ttt. baai. .f ..GlIIoinCllttOf\ ond/ar in....-igatiGftr ." "'., opi"ian d.gth .cxCUfr.d ."
<br />the ti..... dot. and pl.. ol"d dll. IV tft. (Q,,"{\) ,telt.d.
<br />
<br />2""_ (Si,naf"'" oltcl Ti".} ....
<br />A E (Mo. Ooy. Yr.'
<br />
<br />IHOUR Of DEATH
<br />I
<br />2~.
<br />PRONOUNCED DEAD (Hour)
<br />
<br />M
<br />
<br />20400.
<br />
<br />M
<br />
<br />(el
<br />PAIT
<br />II
<br />
<br />
<br />YLeager M.D. 620 North Denver Hastin s, Nebraska 68901
<br />DATE RECEIVED BY IEGISTRAR (Mo, Day. Yr.)
<br />./ '26b. US 281979
<br />A . UHf / ,I (01. (tOl,_fC)), -.'.if,", ...'-,,"~. . :,' --, ""T"~~ f~<J dec"'_
<br />._~, -. ....,-... -~f.p~-y'----L<,- ; ;3 ~
<br />
<br />~:-c_~~- j InlmU'?::::dnrh
<br />
<br />~ ' 'nre,..ul b.,....n 0111" ond d""rh
<br />
<br />, '1 r?k-/),
<br />
<br />~~:-...
<br />
<br />2~r. Clyde L.
<br />IEGIST.".1
<br />
<br />
<br />AUTO'S'
<br />(Sp4J(.i1t Y.. Dr f'l4f1)
<br />
<br />No
<br />
<br />WAS CASl IffUlfD TO MEDICAl
<br />lX-INlR Cl-' COIlONU
<br />(Sp.dft Y.s a, Nfl'
<br />29.
<br />
<br />.:.
<br />
<br />AC(:IDlNT. SUICIDf. "OMICIDf. UNDET. DAn Of INJUR' IM<>.. Da.. Yd
<br />~ '(NIII"G INVf:ion_TION. (5_,1-,' .
<br />I
<br />300. JOb. 30<.
<br />tNJu.... A1 woali. puce OIIWUIY - AJ ~. Jor_. ..f...tllf. foctory.
<br />";';~t'r 't_ VIP" "''11'1 ..f'l.... ~",U~j,n,. ~, "~tly'
<br />
<br />HOUR Of INJun
<br />
<br />:J.Oo .
<br />
<br />JO!.
<br />
<br />M ! 30d.
<br />I lOCATION
<br />
<br />3OQ.
<br />
<br />SllUT OR U D. "'..
<br />
<br />CI'" OR 10\11'" STAll
<br />
<br />r
<br />
<br />~.,J
<br />
<br />.-
<br />Lot Seven (7) and the Easterly Half of Lot Six (6), Block Three (3), Gideon's
<br />Addition to the Village of Doniphan, Hall County, Nebraska.
<br />
<br />Indexed on:
<br />
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