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<br />WHEN'THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES
<br />SYSTEM, "CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECORD.ON -F1LE,WlTH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA T1STlCS:SEtiKHI,'"WHICHIS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. . ~.:./~...}~."":{:"i ]1d.-~c- .'. \...'.
<br />
<br />
<br />DAju'N/SSsA2001 20060995l~~~~
<br />
<br />LINCOLN, NEBRASKA HEAL TH AND~ANSERVlC~~.SY-ST"tIJt;
<br />STATE Of NEBRASKA- DEPARTMENT OF IlEAL ill AND HUMAN SEItYJCES fiNANc:E:i\Np SIl5'ORT
<br />
<br />CERTI~7~~S~~;~EATH - ., -~-~,- ~~ 01
<br />
<br />0613;:;
<br />
<br />11 l'1..CLUCN'l"-"NAMr ".--. FIRST
<br />
<br />
<br />h.cir'Y.;';:'iD STATE 01 BIRrH'-llInQI'n:~~a:ec;;;~;;;;;'-;---
<br />
<br />MIDlJl[
<br />
<br />L.AS!
<br />
<br />~ SEX
<br />
<br />). DATE OF D!:AT'H~.'.':""Morlm a,lv \l~~l;I-'..
<br />
<br />Nebraska
<br />
<br />Marie Schweitzer
<br />
<br />~a AOF Last B\I"thda~y _ UNDER 1 YfAR
<br />(Yf~ I 5b MOS I DAYS
<br />84 I
<br />-~~ -- 6a PI.ACEOFDEATH
<br />
<br />Female
<br />
<br />May 25, 2001
<br />
<br />UNDER' DAY.
<br />Sc. HOURS I MlNS
<br />
<br />8. OAlE OF BIRTH
<br />
<br />IMcmrn. D<l'v Ye.=lr)
<br />
<br />~ Wood RL ver ,
<br />:I 7 ~()CIAL sr::.CuRTIY NUMRfR
<br />J
<br />1 505-76-9982
<br />~ 8n ~'ACIUTY - Nar"r)e f/frJo/-,nstiWfion. 9JVP..5~~8IandnumDerJ
<br />
<br />~ Good Samaritan Center
<br />l3r: City rawN OR LOCATION OF OEA"T~~
<br />
<br />rv1ay 25,
<br />
<br />1917
<br />
<br />HOSPITAL D Inpi'lllent OTH~A ~ NllrSln\! H()r~H'l
<br /> D E.H Oulpatienl D Reslder~ce
<br /> D OOA D 01her ISpeCdv! _.
<br />
<br />I Wood River
<br />9. ~::;_;~:E .---.-r;:~~
<br />
<br />10 RAe!::.. (e.g., Wnite, Black American Indian 11 ANCf:STRY le,q lIahan. Mexl<;:an, German, etcl
<br />clel ISOCCilyWhi te ISOCGknnan
<br />
<br />
<br />_ 14a USUAL OCCUPA TION IOll/e klfla 01 wOf.ll done dwmq most 1_'_40D:xneKIND O~.sB..U.tSINiEcSS INDUS fRY
<br />.] 01 wOr"klng life. even If relir8dj .
<br />
<br />.. Homemaker
<br />
<br />1'6 FATHER. NAME FIAs.i MIODL[ LAST 17 MOTHEA
<br />
<br />
<br />9d, STREET AND NUMI3l::.R (Including ZI{1-(~;;d8J
<br />
<br />912 INSIDE CITY LIMITS'
<br />
<br />8d IN SID!: CITY LIMITS
<br />
<br />'COUNTY OF DF-A TH-" "~....
<br />
<br />150th Rd. 68824
<br />
<br />Yes 0 N() [Xl
<br />
<br />13, NAME Of SPOUSE Ilf wde. give ma/(1erl name)
<br />
<br />Alarion Schweitzer
<br />
<br />i 5 FDUCA TlON (Specify only nighest g~i;ld~ complot~El ''''''~_
<br />Elernent3s or Sel;ofldary 10 , 21 College 11..1 o~ 7"!'
<br />
<br />MIDDLE
<br />
<br />MAIDEN SuRNAME
<br />
<br />i Aaron Beckler Manerva
<br />ii'18 WAS DCCEASED FVF.R IN U.S, ARMErJ FOR(;.ES? -'.-"-"~9~1, INFORMANt. NAME
<br />N;;O:~~, Iii yes g".w., andOJles 01 se,v,ml . _,L Alarion Schweitzer
<br />
<br />19b, INFORMANT MAILING ADDR!:.SS"."'""'. ISH-lEET OR R.f:- () NO. CITY OR TOWN, STATE, ZIP)
<br />
<br />Erb
<br />
<br />6562 N. 150th Road Cairo, NE 68824
<br />
<br />i~jBAIMER /~""'''~''~""'oo /< Vi" r' "C~''"'~;'''~
<br />
<br />P1 ~~. ~ _ ~J Bural D Removal
<br />22a FUNERAL H~) A
<br />
<br />Apfel Funeral Home D C"m."c" D Do",I'o"
<br />220. FUNERAl. HOME ADDRESS IS1HEET OR R~F~'6 NO CIlY OR TOWN. SrATE~ZIPI
<br />
<br />21b, DATE ?1c 'CEMETERY Qi=i"(';R!:MA lORy NAME.'
<br />
<br />5/30/01 woo&~~hr~~g~te
<br />
<br />21d CEMETERY OR C~~i::MATORY LOCAlION (;IfY OR TOWN STATF
<br />
<br />wcx:x3. _.~i ver '.. NE
<br />
<br />411 West 11 th P.O. Box 126 Wood River, NE
<br />23 ~. IMMEDlAl E:. CAuSE \ I r -:-~-~_. tENTER ONLY ONE CAUSi:. PER lIN!; FOR (a),'lbl. AND (ell
<br />i P~H,~, vvto + M 1'&<.-'1-; C- ~ ~....... Cay ~ .......
<br />i 10~tJErO:f:>~(:N~ C&AA~ ~LI1~
<br />
<br />DuE -rOo OR AS A CONSEOUENCE OF
<br />
<br />68883
<br />
<br />Interval b~lween Of1Sel a.M l~att'
<br />
<br />Co UJ-eQy 5> _
<br />
<br />Inler\lal between onset "nd eje,)lIl
<br />
<br />Inlervfll h~lweo:-!n Op~<.:'T :In(! (~,:.:,!~'
<br />
<br />lei
<br />OTHF.R SIGNIFiCANT CONDITIONS. Conditions contributing 10 lt1e ctei;llh bUI not related
<br />f'AHI
<br />It l'\. ~
<br />
<br />260 DATF OF IN.Jl,JRY /Mo" OilY Yr.) 26e HOUR OF INJURY
<br />
<br />
<br />24 AUTOPSY
<br />
<br />25 WAi CASE REFf.RRFci~i () MEDICAL -
<br />EXAMINFR OR COHONER'!
<br />Yo"~ . r-l No RJ
<br />
<br />?fi"
<br />
<br />SIlicide
<br />
<br />o
<br />o
<br />
<br />l,Jndelerlt'llllcd
<br />
<br />II
<br />[J
<br />o
<br />1--
<br />
<br />AccIdent
<br />
<br />Homicide
<br />
<br />if1vestlgi'!.tlon
<br />
<br />M
<br />
<br />26l7! IN,iu'f;,"Y-.A-l 'WOAS]:/6i'" IJ. LACE OF IN.JUHY". At hOmr"."'lam1. ~Ircet. 13Ct~Y
<br />. nHlce bUildIng, et(~ ' /8wcdy
<br />
<br />Yes 0 No D
<br />
<br />._---".,'". , .."'.'" ..,...._-'~.-
<br />O(lY Yr,}
<br />
<br />f"\~r\dlr"\9
<br />
<br />26g LOCATION
<br />
<br />STRi::.r:: r O~ R F D NO
<br />
<br />CITY OR YOWN
<br />
<br />STA Tf..
<br />
<br />2-?a DATE OF DE'ATt-i tMo
<br />
<br />i8'a'.~F6..-iMO. Day. Y,! -.---i28b'iIM[ or DEATH.
<br />
<br />M
<br />
<br />~ "., 5' ~;J...!> --0 { ,~~ ~
<br />
<br />-! ~ u, 2lb DATE SIGNW (MO. Day ;;-;..........-----[270 T1M-~ OF DEATH -..-. @ ~ 6 2B' ORONOUNCED DEAD (MO [;;;YU.-.- 2Bd PRONOUNCFD DeAD l"ouO
<br />
<br />~~\~ S'~I-O/_ I ;?'~;55 M H~g
<br />
<br />_ ,0. ;) 27rl Tn the best of my knOWledqrr;ud h 0 ct 3t the lime date and plac:e and due \0 thE:'! ~ ~ ~ 26e On the hasls 01 m:amination 8M'Of investlgal1on. In my opinion de~lh (KCurfOO
<br /> at
<br />I callselsl 51i;1lp.d ~ ~ ,> ',> !t1~ time. date and place and due to the causels) slated
<br />
<br />~~t~renndTilI8)" _ lSI nalureandTllle ..
<br />29 DID TOBACCO USe CONTRIBUTE' TO n,[ DEATH' HAS ORGAN OR TISSUE DONATION BEEN CONSIDEReD?
<br />
<br />DYES .00 NO D UNKNOWN D YE::S ~~O
<br />
<br />M
<br />
<br />3'
<br />
<br />fQ NO
<br />:cl;~;dSS;;.E'Rlr;:H;hA;J~~ONfRSPHV~';~ORC;:;Y~TOHN[VI, Ir;;;;~ ~l/O/) tra/ld 1sta~ AlE
<br />'" ".00;'","-__ .-3 ~A~~ <'fl''''''''''"J"U'~"'" '4 2~'~1
<br />
<br />30.b WAS CONSf:Nl GHANTED'J
<br />DYES
<br />
<br />fefgiJ~
<br />
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