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<br />
<br />
<br />DECEDENT - NAME
<br />
<br />FIRST
<br />
<br />~ "TE OF NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF D~ATH ~_
<br />MIDDLE LAST SEX
<br />
<br />
<br />200605798
<br />
<br />Venhaus
<br />
<br />1919
<br />
<br />Hall
<br />
<br />IF HOSP. OM INST. Indie,,'. OOA..
<br />Olitpatl."t/~m.r. 1m.. lnpolient (Specif.,)
<br />
<br />l<4bGrand Island
<br />RESIDENCE -STATE COUNTY
<br />
<br />150, Nebraska lSb. Hall
<br />FATHER~NAME FIRST
<br />
<br />West Avenue
<br />FIRST MIDDLE
<br />
<br />INSIDE CITY LIMITS
<br />(Sp..ci!,Y,Y... 0' No)
<br />15... les
<br />LAST
<br />
<br />Venhaus Elizabeth Kleine
<br />INFORMANT _ NAME _ RELATIONSHIP ~ MAILING ADDRESS (STREET OR R.F.O. NO., CITY OR Tow'lSel5~l'P)
<br />
<br />Ii Brs. Rita Venhaus-\.Jii'e- 2 West Ave. Grand Island;Ne
<br />CEMETERY OR CREMATORY _ NAME LOCATION CITY OR TOWN STATE
<br />
<br />I '18 Calvary Ceme te
<br />FUNERAL HOME-NAME AND ADDRESS
<br />
<br />20d. Grand Island Ne.
<br />(STREET OR R.F.D. NO.. CITY OR TOWN. STATE, liP)
<br />
<br />23b.
<br />DATE Of DEATH (Mo.. Do" y,.)
<br />
<br />23<.
<br />
<br />2<4<. 8: 20 a. M
<br />PRONOUNCED DEAD (Ho~,)
<br />
<br />H.. 8: 8
<br />
<br />a. M
<br />
<br />23d.
<br />NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, CORONER'S PHYSICIAN OR COUNT
<br />
<br />25. Richard E. Weaver, Dep.Co. Atty./
<br />~ REGISTRAR (lrY?' , fjM'.. /J ~ ~J
<br />'1~1 / ah.. t-tJ2...; " . -t.~4(}-kC"--'
<br />260. (Si,natur.) ....
<br />27. IMMEDIATE CAUSE
<br />PART
<br />~ coronar occlusion
<br />DUE TO, OR AS A CONSEQUENCE OF,
<br />
<br />W. Is~ st.,
<br />
<br />, (: ,~ '" :;:~:_-.,..,,;.;;,.
<br />f ""'l
<br />
<br />I hltot'Vol betw..n On..' Clnd death
<br />,
<br />.: inunediate
<br />
<br />InhuvQlI b.tw.on an.et and d.CI,h
<br />
<br />(ENTER ONLY ONE CAUSE PER LINE FOR (0), (b), AND (<))
<br />
<br />tbl m1l1t.;~le sclerosis
<br />DUE TO, OR AS CONSEQUENCE OF,
<br />
<br />....." ,
<br />
<br />ten years
<br />~1't1.l"Yol b.tw..", on,et and d.o,h
<br />
<br />~ ~.
<br />
<br />
<br />WRE'M~T~:::j:~y CARRIES !:~R~: SEAL J~:':'~~-:1J
<br />
<br />STA"TE DEPARTMEJiT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A TRUE COpy OfoAN ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTMENTOlf.,)tEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IsfllFo,L]:'GA1:~~:EPOSITORY FOR VITAL RECORDS.
<br />. ~. ""-:;'
<br />
<br />
<br />SIR iTO " D. No.
<br />
<br />STAle
<br />
<br />fcl
<br />PART HER SIGNifiCANT CONDITIONS-Condition. contributing to d.oth bloit not r.lot.d
<br />II
<br />
<br />ACCIDEN'. SUICIDE. tiOMICIO~. UNOET., DA.n: OF INJUII:Y (Mo., Day. Yr,)
<br />OR PENDING INVESTIGATION. (Sp.d/rl
<br />
<br />300.
<br />INJURY AT WORK
<br />(Spedf, '(.. Of No'
<br />
<br />J ~ ..:tA---:41
<br />DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA Issued September 27, 1979
<br />
<br />/;
<br />
<br />Ii \
<br />
<br />~~\,
<br />
<br />(
<br />Lot S~ve~ty-two. (72), Block One (1), of' West Heights Addition
<br />to the Clty of' &r~d Island, N~braska, and being the same as
<br />Lot S~venty-two (172) of' said West Iletghts Addition as surveyed
<br />and platted.
<br />
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