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<br />Lot light (8) in Biock One (1) in No~mandy l~tateJ An Addition to the
<br />City ot 9~and I~iandJ Neg~a~ka
<br />
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUEGffllY"'''~',
<br />OF AN ORIGINAL RECORD ON FILE WITH"THE STATE DEPARTMEN.:r:PE_Ati~.
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSlt~'t. 'l"Qlt .~,.'i'f>'.) .,
<br />
<br />
<br />::::O:E::::CE tfo60~791 ~J/j~~;;)'::,
<br />
<br />MAY 3 1985 STANLEY S. COQr~:~':~~}'R9W.Q~~~:'
<br />LINCOLN, NEBRASKA BUREAU OF VITA~ fi~'s~\?s\,'~
<br />
<br />STATE OF NE8RASKA~DEPARTMENT Of HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />
<br />
<br />RICHARD
<br />
<br />EO NT-~
<br />
<br />'I'll'vi! .11'1 ~.
<br />
<br />I .
<br />HSlDENCE-STATE
<br />
<br />OMAHA
<br />
<br />COUNTY
<br />
<br />HALL
<br />
<br />I. W.O. KENSINGER I ABBY
<br />WAS DECEASED EVER IN U.S. AIIMED FOIICES? INFOIlMANT-NAMf--I!fLATlONSH'P~tMILlNG ADDRESS
<br />(Y.,. no, Qr I,In.) I (If Y.'_ gift wor (Jl'ld dtll.. ot *....,.1(.) aJ.
<br />lena . .... ..--
<br />BURIAL, Crema'ian, Rema_al OAT
<br />
<br />HELEN
<br />
<br />BATTLES
<br />
<br />(STREET 01 U.O. NO.. CITY 01 TOWN, STATE, liP)
<br />
<br />
<br />01
<br />
<br />200. BURIAL 20b4-22-85 2(;rGrand ISLAND CEMETERY' 20d. GRAND ISLAND, NE
<br />EMBA ER~S'GNATUR~ LICENSE NO. FUNERAI.'HOMi::"'NAME AND ADDRESS (STREET 011 U.O. NO" CITY 01 roWN, STATE, l'f,! b 68601
<br />21. r ~ 2148 2~IVINGSTON-SONDERMANN 505 W. Koenig, Gia~d Island
<br />To I ... of 1ft, know..... chtCl nd pi Clnd d~. tG th.. -i ~ On the baai. of eXG",inatiQn and/or j""It1ga.ion. in my Dpinioft d.(lth O((i,jtr.d ot
<br />rl ca .-led. :!z the liMe, dot. and plo(;. god d.... tQ t+t.. It(i"..(t;) .to,,".
<br />'1i- 23a. (Si ".,u~ Qlld 'iff_) .. TH ...iU~<( ".' 2"0. (Signclfltr. anJ Tm.)"
<br />1: DAn SIGNED~.. 0." Yr.) H f, . "P.
<br />~~ A- h
<br />!!6 23b. PR I q t q~.s- 23< I 9.)? R~ .35i1 24b.
<br />~1 DAlf OF DEATH (Me., Dol', Yr.) .1125 PRONOUNCED DEAD
<br />.... A ,..- '!o ~ (Ma.. Day, Yr.)
<br /><( 23d. . po R. \ 9 i' ~ U 24d.
<br />NAME AND ADDRESS OF CERTI IER (PHYSICIAN, CORONEIrS PHYSICIAN OR COUNTY ATTORNEY) (Type ar Print)
<br />
<br />5. Cu. R,\::1: s L. S t... I\J t:- 0 E'B~ r1'\ [;-0 C (?(VT t R 0 m4HA
<br />REGISTRAR C\~f Cl . /! if. DATE RECEI 0 BY REGISTRAR (Ma., Day, Yr.)
<br />20c>.($i9.0"'.)'" ~ luv.- I r. A P R 2 5 '985
<br />27. 1_~Alf CAUSE (ENTEII ON ONE CAUSE PER L1Nf '.....01 b....... 0.... o.d d...'h
<br />P~.T A-
<br />(01 A-R.- 0 :r::-A c. . <it R. lC?$. ~
<br />DUE TO, OR AS A CONSEQUENCE OF,
<br />(bl R LU.. \' e (3 A-c TE"'RrA-L krV 00 C. A- R DrT:t S-
<br />DUE TO, OR AS A CONSEQUENCE Of,
<br />
<br />24(. M
<br />PRONOUNCED DEAD (Hour)---'
<br />
<br />2....
<br />
<br />M
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<br />(; /; rtoJ'
<br />
<br />In...rwCllI b.tw.." on... and d.vth
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<br />'n"NOI b.~.~ on$" gnd d~
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<br />(0)
<br />Mil "IE. "ONtFtcA.NT COWD.nQN$ ~ (o,,!lfill.. C"o""'lbut;nv to d-.ath but not r.la"cI
<br />II
<br />
<br />ACCIO!NT, SUICIO!, "OMICIO!, UNotT., DATE Of INJURY (Mo.. Ooy. Y,.)
<br />OIl ,fNOING INVESHGATION. ($po<l/y)
<br />
<br />3flO.
<br />.....U.Y AT WOII(
<br />(Sp.c,Ir Y., 01" No)
<br />
<br />
<br />'A.lll11. If fEMAlE, WAS THERE A AUfOflS'f
<br />".f:G~AN(Y IN tHe PA$13 MOH1H$? (S~;frlrr or No)
<br />
<br />V.. 0 No 0 28. I" 0
<br />OESC".E HOW INJUIY OCCURReD
<br />
<br />WAS CAS~ RU!IIEO?t7.--Mf~--
<br />EIlMIINEl 01 COIlO
<br />(SpM.i'r Y.. o.r No) 0
<br />29. .
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<br />3Od.
<br />
<br />STRUT 01 U.O. No.
<br />
<br />CITY 011 TOWN STAn
<br />
<br />30..
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