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<br />~
<br />
<br />STATE OF NEBRASKA
<br />:\ " .
<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND I"!I)MAN SEFni'CES,'
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECtiRiJ?iilfI'U.WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATlSfJPf $ECiiCJN;: w~1ays '
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ~il'~'"
<br />
<br />
<br />DATE O~~~UAt2E 200? AS~~. r;.'..:4.~~T"fA.S.. ..~.N.-i.::R.~E...~.r~~~.-~....J /
<br />LINCOLN, NEBRASKA 200703673 HEALTff,ANiJ HUfltfNfS~r;Jj
<br />.'. ..'~~~~;:~~.}_"::~:~ot~f:,;
<br />STATE OF NEBRASKA- DEPAR~~~;!f~~~;~N~~U~~~~~~~:FI;~ANCEAN5 sUPPolj I ..2_0_llL
<br />
<br />)'il~ I D~C~DENT'S.NAME (Flrsl, Middle, last, Suffix) '-",.2. SEX , 3. DAT~ OF D~ATH (Mo" Day, YI)
<br />~~!1: _________ Joseph Raymond Partington Male January 10, 2007
<br />
<br />1\(1)~i 4 CITY AND STATE OR n,RRITo'RY, OR FOREIGN COUNTRY OF BIRTH 5.. AGHast Birlhday 5b, UNDER 1 YEAR 5c. UNDER 1 DAY 6, DATE OF BIRTH (Mo., D~~,'y~)-'-
<br />J ~ (Yrs.) MOS. DAYS HOURS MINS.
<br />
<br />Lincoln, Nebraska 85 February 5, 1921
<br />
<br />~ 'i r 7 SOCIAl SECURITY NUMBER 8.. PlACE OF D~ATH
<br />
<br />505-16-1887 lillsl'lIAL Olnpati.nt QlliE8: 0 Nursing HomerlTC UHn,plceFeclllty
<br />
<br />~
<br />
<br />
<br />Horne:
<br />
<br />1717 Gretchen Ave.
<br />
<br />FACIliTY. NAME (If not Institulion, glvo straet ana number)
<br />
<br />U ER/Outpatlent
<br />
<br />JO Decodent's Home
<br />
<br />6c, CITY OR TOWN OF DEATH (Include Zip Cod.)
<br />Grand Island
<br />
<br />68803
<br />
<br />'-.:r9b-~~N~all
<br />
<br />U 00'1 0 Oth.r (Sp.Clfy)
<br />
<br />...__..t:G~UNT~~IrTH'-
<br />
<br />9c. CITY OR TOWN
<br />Grand Island
<br />
<br />_..~~~ 9tzIP~~~03
<br />
<br />lOb. NAME OF SPOUSE (First, Mlddl., Last, Suffix) If wll., give m.ldan nam.,
<br />
<br />
<br />9g. INSIDE CITY LIMITS
<br />
<br />~ YES 0 NO
<br />
<br />9a. R~SID~NCE.STATE
<br />Nebraska
<br />
<br />9d. STREET AND NUMBER
<br />
<br />1717 Gretchen Ave.
<br />
<br />lOa. MARITAl STATUS AT TIME OF DEATH OlMarrled 0 Nev., Married
<br />
<br />U Marrlad, but '.parat.d 0 Widow.d U Divorced 0 Unknown
<br />
<br />Patricia L. Gilligan
<br />
<br />1,. FATHER'S-NAME (First,
<br />James
<br />
<br />Middle,
<br />Harold
<br />
<br />L.,t, Sufllx)
<br />Partington
<br />
<br />12, MOTHER'S.NAME (First,
<br />Agnes
<br />
<br />Middle,
<br />
<br />Malden Surneme)
<br />O'Halloran
<br />
<br />13, EVER IN U,S, ARMED FORCES? Give dales 01 ,e'vlcell ya,. 14a.INFORMANT.NAME
<br />(Ye,~J;&Jnk? /l / 1943 6-24-1946 Patricia L.
<br />
<br />". ""OOO,""'Mm," ['.. ~M~~,"""",
<br />
<br />
<br />~::~ ~~:;;.:;" '"''':~"; "~:SO~~e~eterY.
<br />
<br />
<br />17a, FUNERAL HOME NAME AND MAII.ING ADDRESS (Streel, City or Town, Stale)
<br />
<br />Apfel Funeral Horne 1123 West Second,
<br />
<br />Partington
<br />
<br />I=CENS~'~;;.<~_
<br />
<br />-- '".,.
<br />CITY /TOWN
<br />
<br />14b. RELATIONSHIP TO DECEDENT
<br />Wife
<br />
<br />16c. DATE (Mo., Day, Yr.)
<br />
<br />January 16, }007
<br />
<br />STATE
<br />
<br />Grand Island, Nebraska
<br />
<br />Grand
<br />
<br />
<br />
<br />18. PART I. Enter the .tillltln.Pl~--dlsea5es, injuries, or compllcatlons--Ihal directly caussd the death. DO NOT enter termlnel evenls such as ~ardlac arrest,
<br />respiratory arrest, or ventric\Jlar fibrillation wllhout showing the etiology, 00 NOT ABBREVIATE, Enter only one cause on a line. Add additional lines il necessary.
<br />
<br />IMMEDIATE CAUSE (Fln.1
<br />dl!>o3se or condition resultlny
<br />In de.th)
<br />
<br />IMMEDIATE CAUSE.
<br />
<br />(a) .Co Pp
<br />
<br />DUE TO, OR AS A CONSEQUENCE OF:
<br />
<br />onset to dealh
<br />
<br />\.j -Eb.(.J
<br />
<br />onsst to death
<br />
<br />
<br />Sequentially IIsl conditions, If (b)
<br />any, leading 10 lhe c.us. listed -iiUE'TO':OR AS A CONSEQUENCE OF':
<br />on line a.
<br />Enterlhe UNDERlYING CAUSE
<br />(di..... or Injury that Initiated (c)
<br />the events resulting Ind..th) DUE TO, OR AS A CONSEQUENCE OF:
<br />lAST
<br />
<br />onset to death
<br />
<br />onset to dealh
<br />
<br />(d)
<br />
<br />18, PART II. OTHER SIGNIFICANT CONDITIONS.Conditlon' contributing to the d.alh but not 'e5ulling in the underlying c.us. giv.n In PART I.
<br />
<br />(1'M k..xc_'~ "lhd 1.&.
<br />
<br />20, IF FEMALE:
<br />
<br />Or2(T(?-\ .
<br />
<br />'_...... -~:J. __.~KI \(J.l""(..du.1<.. _
<br />21a. MANNER OF D~ATH 21b, IFTRANSPORTATION INJURY
<br />'~.tural 0 Homicide ODriver/Oparalo'
<br />
<br />19. WAS MEDICAL EXAMINER
<br />OR CORONER CONTACTED?
<br />o YES t;( NO
<br />21c. WAS AN AUTOPSY PERFORMED?
<br />
<br />
<br />o Not pregnanl wilhin pa't ye.r
<br />o Pregnant etllm~ 01 deetll
<br />U Nol p,egnenl, but pregnant wifhln 42 days 01 d.ath
<br />o Not p,egn.nt, but pregnanl 43 days to 1 y.ar b.lo,e deatll
<br />o Unknown If pregnanl within tile p.st yee,
<br />-22. DATE-OF iNJ-uRY;Mo~Day:y~.1l22b. TIME-OF INJURY
<br />.,....,..."...1. m
<br />
<br />22d INJURY AT WORK? _.122' DESCRIBE' HOW INJURY OCCURR~D
<br />
<br />
<br />o YES 0 NO J
<br />
<br />
<br />221. LOCATION OF INJURY. STREET & NUMBER, APT. NO.
<br />
<br />o Acctd.,HO Pending Inv.5t1g.lIon
<br />
<br />COMPLETE CAUSE OF DEATH?
<br />o YES U NO
<br />22C PLACE OF INJURY.At home, lerm, .Ireet; f.ctory, offlca building, construction slle, atc (Sp,clly)
<br />
<br />[J Passenger
<br />o PedeSlrtan
<br />o Oth.r (Sp.cify)
<br />
<br />o YES
<br />
<br />~NO
<br />
<br />o Suicide 0 Could not be detsrmined
<br />
<br />21d, WERE AUTOPSY FINDINGS AVAILABLE TO
<br />
<br />1..J) (j,
<br />
<br />CITYIfOWN
<br />
<br />STATE
<br />
<br />ZIP CODE
<br />
<br />23a, llAl E OF DEATH (Mo., D.y, Yr.)
<br />\-110'01
<br />
<br />24.. DATE SIGNED (Mo" D.y, Yr.)
<br />
<br />24b. TIME OF DEATH
<br />
<br />m
<br />
<br />z".
<br />~~~
<br />]liiilt
<br />di~~
<br />a.D..=-X~
<br />ElI)tZ
<br />8[5,,0
<br />.8~5
<br />~~CJ
<br />85
<br />
<br />m
<br />
<br />
<br />24C. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD
<br />m
<br />
<br />23d. To the bast 0.1 my knowledge, death occurred. at Ihe time, date and piece
<br />.r~t.~~ c.u,.(s) nt~d. ~Slgnalure and Tilla) "
<br />
<br />(...-t/Jj \N.-\...\tDA ~
<br />
<br />24e. On Ihe basis 01 examlnallon and/or Investigation!.in my opinion death occurred at
<br />the time, date .nd place .nd due to the causer,) SI.ted, (Slgnatu,e end TltI.) "
<br />
<br />25, DID TOBACCO USE CONTRIBUTE TOTHE DEATH? 26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? 26b, WAS CONSENT GRANTED?
<br />
<br />'5(VES 0 NO U PROBABLY U UNKNOWN . 0 YES...~' Not Appllc.ble il 26. Is ~O 0 YES ~O
<br />-"2"7:NAME, TITLE AND ADDRESS OF CERTIFIER (PHYSICIAN, CORON~R;S PHYiHCIAN 6R'COUNf~E;r') (Type-or P,lnt)
<br />Kimberly Mickels M.D. 729 N. Custer Ave., Grand Island, NE. 68803
<br />
<br />26a. REGISTRAR'S SIGNATURE
<br />
<br />
<br />28b, DATE FILED BY REGISTRAR (Mo., Day, Yr.)
<br />
<br />JAN 2 6 ZOO?
<br />
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