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<br />Ot 'liNT .N
<br />'4NINT INK
<br />dnUCTION
<br />\AHUAL
<br />
<br />.1.................
<br />
<br />Tract No.
<br />
<br />..................
<br />~-80
<br />
<br />STAn Of NfI.IIASIlA-OlPAATMEHT Of HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF Or.ATH
<br />
<br />88- 100943
<br />
<br />DECEDEHT-NAMf "l$--r-- M'r'Dlt - --- - n_ ""v.!W.. -1$lX-rATEOfOr.TH eM"., Do,. Y'.J
<br />
<br />1 Olive Eva .iioHI\:man dp.tna1e 1 March 29, 1982
<br />RACE -(..g.. Whit... Block, Am.ficon CHtIGIN/DfSCfNT(._g~I;;';II;"n:-Ilo'."o.:~~~~,. ",- i.l.-t-':',,;, .,,;~.;..~ Nl'~_.~t:il;.)~-.!. DAY rOATE Of BIRTH IMo.. Do,.. y, )
<br />'ndian. .k.J(Sp.c,'y) O.rrnon. .lc HSp.cil,.J -;v.. J MOS_ . DAYS I HOUIit~ MINS.
<br />. White 5. Americ'\n ___.d...Lo.. !~___ 6b _;"'_.1."'-.-: 17. Jan. 28, 1909
<br />CITY ANO StAlE Of "ltH {f no' in U.S..... CmIEN 0' WHAJ COL." iRYI:....'r.:"u D. NEVER MARRI(:O. ; ....Aldf Of SPOust ill .,.if.. gi... moiden no",.,
<br />nom. coun'r,} IWIDCJWEO.DIVORCfD(SP.Ci'y} I
<br />I Humansville. Missouri 9. U. S. A. :0 l-Ian-ied " Walter Horstman
<br />.oc tAL SECUalTY NlJMIER USUAL OCCUPAtiON IG,.; .lnd 01.-0'. don; i...;;nii-;;o:C;, KINOOf8USINf~S OR INDUSTRY' COUNNOiDfiT...----- ----
<br />. 01 wora;...; III.. e..n ,I ,.t"ed)
<br />12 507-14-1487 130 Housewife 13b Domestic lOo Hall
<br />(tIY. TOWN oa LOCATION Of DEATH INSIDE CITY LlMIfS1HOl)PITAl OR OTHER INSmUTlON - Name III not in eillt.,. If hOS' OllNSt l"d;co,.OOA
<br />15p.c;'lY.' or No) un.. \l,.e' Qnd numb." . Ovlpoh.nIJf_, ... l"poll.,,1 Upltt".f"
<br />lOb. Grand Island 14< yes l.d Lut~eran Nemoria1 Hospital lO.. Inpatient
<br />IE$IDENCE - $T...n COUNTY FTOWN OR lOC...lI0N--- $TRUT ...ND NUM8ER IN$IDE CITY liMITS
<br />
<br />150Nebraska 15b. Hall 115< G:and Island lSd 117 \~. Bismark :~~'''f, 'f../itito'
<br />
<br />fATHER NAME ::r1es :~~~~-~:--~t:~:IfHE~MAILfNN""'E f;~~ MIDDLE Stoc~~~~~-
<br />
<br />WAS DfCEASfD EVE'IIIN u.s. ARMED fORCES? INfORMANT - NAMf -IlHAflONSHIP - MAILING AOOIil:fSS (SlIlU 01 If'Nlf; ClfTEfat3tJJ' ~1A.1t_ llPI
<br />
<br />\T:,. n'N'o..'T" ,....'....'.nd..o...,....,'"1 19 \la1ter Horstman-Husband-117 W. Bismark-Grand Island,
<br />
<br />eURIAL. C,.mo,ion, Remoyol OAt eEM. ETli~.I)R CR-(M..t..TG.j"'Y-~AM. E. . .-l:6C...T10H CITY OR JOW':'-- -SIAH-
<br />
<br />2D~ril 1, 1982 2Dc Grand island Cemetery 2Dd. Grand Island, NE.
<br />ye $V:P-H. '/.. fUNER....l HOME_NAMfn:4iiiiA.DDRiSS..--- ",",,;011'0 No::cmo.,owN.Si.n:Zig8801 ---
<br />
<br />t!;. .,~pfe1-Butler-Geddel' 1123 W. 2nd, Grand Island. NE.
<br />Z Of D A .. i:, - --- - ------1 ~-:lD.l.E SIGt ~O(Mo Day. Yr.) IHOUR Of DEATH --.-
<br />h 29 9 ' . - ~ I
<br />30. arc ,. 2 I~~f, 1240 2.b M
<br />.t... DAn SIGNED {Mo.. Do,. Yr.} HOUR Of Of A'" ~~a: P.iONOUNCEO DEAD 'PII:0NOllI'~CfOOEAO{H-~'
<br />n i~ MM,t ~, }c./OJ,... 5'05 A M r~~i;;~o Do,.Y"
<br />... u.r 23b vtA. 'D- _1 0 1J~_+ _ ~~_ II. . ~i ~ ,~'" 24 __ lfL.._
<br />::t .! f. 10 I.... &t... of _, "'.-1..1&.. d_tlrl; ou..".d Ollh.~.. c401. u"o lolot:. ond ....... 10 '1'1. --,~ ,.,0 IOn the bOllt of ."0"1"01101\ alld/o' ..'...I,g...'...., '" "'J' oplnUI" d.01h oct:.....d QI
<br />- . f collM(d .to~ ~. ~ k Iou V I,.... h~ dol. a"" f '0(0 0,,;:1 d... 10 th. co....hl ,tat.d
<br />'.. ..., I 1"'0.'
<br />.I.' 2Jd (S18ItGh;reondlltf.,'" I ::) ~ : ..JC' ~J'e f)U"Oh'l.,...,t(I,.rf.'~
<br />; NAMf ANDAOORfSS OfctlilTlflEI (PHYSI A,'04. -iii: 1'5-" IYSI-;AN"OR (,l....INly Ane:' "~;'--;';r::~IPfl"'~ - -~ -- - ----- ----- ---
<br />
<br />
<br />2$ W. L. Fow1ea M.D. 1811 W._2ndL Gral..~_ !.:;}.an.c!->...~~. _~8Q.L-._______ .
<br />llGI$T..... I...n atU VEO 8Y REG'$I.....R (Mo. Do,. y, '
<br />
<br />26a.lSigIlO'"'.'. 26b
<br />:~./Y.MIDIA'~ CAUSE , (fNrl. ONLY ONf C~USf PEa liNE '0. (~J. (~). AND leii ---- -- -- -. ----;--':'."'01 b.;'::;; ';';1 ::0.., O."lh
<br />
<br />101 Lv"'-.Ll'-'\..-x. /lr-O"".Jc.....v.d...\ (t("c...:4\..~1 : 5....rc,(1..';
<br />~UE TO, Ol.< . CON<EQUEHCE Of, - - - - -- --+--- - .
<br />."1 Cl~<~\' S "QIVk.J. ...v-L.~_l~~~~I~-O~~ _l'n""ul~;~~~'~:~:d'~~_
<br />
<br />OU('O.olASACONSlQUf~a?f. , -------~- .. . ''''.,...ol~on..lofldd.a~
<br />Cd 'l~,,-<,)~..~).'JI c.:.kl---i.."'-C-.,UA..G.'-"-~ : c-'('.,_.t.l-
<br />'AI' OJHII $IGlL,uCANJ CONDI!ION'-'-COftdlhQ-"~,,tflbllh"8 1~-JM'lh bll' "01 ,.Ia'~ --- ---- WAS CASt IU\\ilDlO--""iOiC.i ----
<br />II l~~~~~~:,~~ ~~,IOHU
<br />19 ,......
<br />
<br />
<br />DAn Of INjUn loMo, Do,. ",
<br />
<br />
<br />300.
<br />INJUIY A' WOI&
<br />11"-1" r.. .. H.,
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<br />JOb. llk" LlO'- _ __.
<br />'lAC' Of INjUn - AI ho_. '1;1'.. ,If_t, tact-;;,. ---,;O'C;'...:..H. - 'itllEt O. I f D. No
<br />.ltic. blllldi"iI..k. U.~"f" I
<br />______~.iL___ __._
<br />
<br />Cln 01 tOWN 5tAIl
<br />
<br />JOe.
<br />
<br />PT FR Lot 8 Blk 5 South Grand ISLAND ADD TO THE CITY OF GRAND Island
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