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<br />88-105152 /"'~'~""
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE.:N~ "S~ATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOIi,'T)k
<br />OF A~ ORIGINAL RECORD ON FILE WITH THE STAXE.D' .
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE IiBG~ D . 4Il'
<br />VITAL RECORDS. ,: i.': .. l,c:;'Ejf; ,
<br />li~'~'i:iM.'J 7..: ~.: ~J"}"r.
<br />DATE OF ISSUANCE ~~,,"':""~ /"~'
<br />JUL 141988 STANLEY's1:~o.~~R.{"'DlRECTOR
<br />LINCOLN. NEBRASKA BUREAU OF VITAL STATISTICS
<br />
<br />
<br />STATE OF HEIRASIiA-oEPARTMEHT OF HEALTH
<br />IUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
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<br />.;;Z~ ~1;~r~D~V:~:~~.~. ~:'I~, ~~:~S,
<br />
<br />lOAn
<br />
<br />Jacob
<br />
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<br />i IN'OIMANt-~ -NA;;j'f':~""'iw'ONSHii.~illl'm AODI[SS ('filii 01' f D NO en" O~~lJj'''''f. 11'1
<br />!II' Hazel Geist. lHfe, 4116 Mason Ave., Grand Island, NE
<br />ICf....ITl..,OIOfMAlOIT-N.... - - --- lOCATION ClnO.TOWN STAn
<br />
<br />Geist
<br />
<br />Narie
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<br />INSIDE CITY LIMITS
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<br />u.Yes
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<br />Adler
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<br />".,Nebraska
<br />.. 11 -HAM
<br />
<br />I'" Hall
<br />
<br />MIDOU
<br />
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<br />27 1988 :100l Grand ls1am,t Cel!1e_~e!:'y lOdGrand Island Nebraska
<br />~;,t fJ 7 i fUNU..' 110..1 - N......' "NO "OOIUl .IUIU 01" It NO (." O' TOWN, "An. ''ttE 6880 I
<br />21 122 Apfel-Butler-Geddes. 1123 W 2nd Street. Grand Island.
<br />---r DAn SIGNfD ,..... DDp. 'I< I 'HOUIl Of DIAlH
<br />'!U,.. 6/28/88 I". 11:00 p. M
<br />IHDUI Of Df.UH u---i.J~5. :,lioNOi.iNti'DD'fAO l'IONOUNCfDDfAO'HDurl
<br />M I!;P',:; 0-, '/;';24/88. a.
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<br />2111 '1......_."" r.~..... u. ].. I...~..... .... ,..._. ~ 1. I
<br />NAMl4H ADOllUS Of CUl"llIll'HYSICIAN, COIOWIIl'S, '"'SfCIAN Oil COUNTY AnOIlNEY) ,T,P. D' ,..."
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<br />23 Jerorn E.
<br />IlIGI1JUIl
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<br />fi,QQIJ]
<br />
<br />260 Is..--,~
<br />27 lMMlOlAII CAUY
<br />'! cardiac arrest
<br />DUE 10. 01 AS.. COH$fOUINCI Of
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<br />out 10. 01 ..s.. CONSEOUINCE 0'
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