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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATI$.TIC~sEt,~;=-"W#!CH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ~' ~,'=- ~jl~, :i~=J~,F--, .~o, C~fo,:!:'
<br />
<br />DATE OF ISSUANCE ~. _~" ~:.p:=:-=',~ '~;-'.::
<br />U N 0 1 2 0 0 7 0 4 6 4 5 ff~" -. TANLEY"s....cci.1i
<br />J 2007 'ASiiSiAN7'$i#:~'llifG1S1}fAti)
<br />LINCOLN, NEBRASKA HEAtf/rH-A~/iHUMAN SE~ytjjES
<br />
<br />1ll1;C~._
<br />
<br />_ . ~,', - .---. '--":'T
<br />
<br />STATE OF Ml8RUU-DEPAllTMEMTOF HEALlH AND HUMAN SEIlVICIII)NAllCl!, ",',;~,~,,',' "',', ----' ,0,6'952
<br />. VlTALSTAnsTICS ,- "",. - "'",-tlj
<br />CERTIFICATE OF DEATH m .,,'_ _ '_ . "" m ,
<br />lAS1 2 &€X 3, DATE OF DUi'" ,_ 0.". _
<br />
<br />FlJIST
<br />
<br />"'DIll!
<br />
<br />
<br />Linda'
<br />tltWltit"JSA.. _"""",,,'
<br />
<br />Female
<br />UNDER 1 DAY
<br />$0 HO\lRlI _
<br />
<br />June 10, 2003
<br />.. DAT( OF "'TH _t>>y V-.j
<br />
<br />
<br />Grand Island, Nebraska
<br />'7. SOCIAl SECuAT1Y NUUIlER
<br />
<br />'" PlACE Of DEATH
<br />~~ 0-
<br />DER~
<br />DDOA
<br />
<br />;!!.~R
<br />
<br />October 10,
<br />
<br />0"",--
<br />I!l~
<br />D (lIhor ,..",.,
<br />
<br />1938
<br />
<br />506-40-1331
<br />.. F._ 11I""'_",___
<br />
<br />3180 South Blaine Street
<br />ec, CITV TOI'INORlOCAllONOFllfA7H
<br />
<br />.-.- Grand Island
<br />110. RESlDEIICIi. STATE
<br />
<br />
<br />ea ,_ Gi7Y L.MTS' .. COUN1'Y OF 0EA7H
<br />
<br />Nebraska
<br />
<br />10 ....._._.__
<br />
<br />1I<,I'5oo<oIyl
<br />. White
<br />
<br />14-1 USlJAI.OCCUl'ATIQN ,_Wtlt__ttnw_
<br />tIt--..,_ --".".n
<br />BooKKeeper
<br />
<br />'. FATHER. NAME FIlST UIOOI.E
<br />
<br />Bill Baasch
<br />15 EOuCA11llN ISlloc only .... """'-1
<br />ElomonIoIvrrv 1~.'2J 00II0ge ".."".,
<br />
<br />MIDOl.f MAlDEN ~
<br />
<br />Edmond Van
<br />18, WAS 0 EV!R IN US, _0 FORCES-
<br />f't". !'WI.Of..... lit.,. 9'v8*"_dlMs~~1
<br />no
<br />lib ,,*0AMNfT ~IUl\lGAOORESS 'STAEETOFIIRF0 NO. CIT'rOft, tOWlll StAfE; ztPl
<br />
<br />Alice
<br />
<br />Reinecke
<br />
<br />3180 South Blaine Street
<br />20 Et.IllAI.MER. SIGNATURE & lICENSE' NO
<br />#flRr
<br />
<br />68801
<br />
<br />Grand Island Nebraska
<br />2.. I,lETHQO OF OOSI'OSlTi01II 21. DATE
<br />
<br />i 21e C{UETERYORC""UA'OR" "AlAE
<br />
<br />
<br />[1!lllut,.. 0 """"'," June 14 2003 Grand Island Cemeter
<br />2'. CEME7ERV OR CRE.....ORV lOCA'OON Oh OR'~ STATE
<br />
<br />A fel-Butler-Geddes Dc_ DOoN""_l_~_ Grand Island, Nebraska
<br />_ ,FUN IIAI. HOME ADDRESS IST"IiET OR R.F 0 NO crr" OIl TOWN STATE.llPl
<br />
<br />1123 West Second Street Grand Island, Nebraska 68801
<br />23 IMMEDIATE GAUSE _ ./ IENTERONlVONE CAUSE PERLIN! FOR,., '" AHDleli
<br />p~ rnU /-h' - ,s I..I~ ca.....:... u.r c-
<br />lal -r
<br />
<br />p>1;.ORAS:;;;i~~00 5 kb<!LJrfiCl al dt' m~" rIa..
<br />
<br />DUE TO (lR All A CONSEOUENCE OF
<br />
<br />"""al ~ Qr1QM ~I\O I)t~.
<br />
<br />approlit'. :< w-eelS
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<br />OTttER OONlfi'tCANT COt\fOITl(WS CCJ1cJrtIon5 Conl;'~" to M dNtn but rd 'eta~
<br />P~R. OJ" D I hLfper~ns ,'01'1 t '1-'"1f&id d,'6 e4Sl!
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<br />PAc;ol111 IF fE~Al[ WAS THEFIf A
<br />P~l.Gt,lANC'r IN tHE P4ST ,~..,.Ot.lTHS"
<br />
<br />1;?4 AiJTOPS'"
<br />
<br />I" WAS L'S~ REFERRED TO MEDICAl.
<br />I ~XAutNEJ;tORCC.~A""
<br />V.. 0 No fXl
<br />
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<br />.. i 26b OA tE OF INJURV fMQ ~~ 'f', J l:t&r ...oUR OF I~JlJAY
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<br />Os""'.... 0 Pond,... I. INJU'lVATWOR. 1211' ~LACEJI"J'!"V.AI_"."''''''''''''''''
<br />, otIic.l!' 6ubno @I(. ,'SOft"'J
<br />o ~oMIt. In;,tt}5tIQiOOl'l I VIM D No. 0 f
<br />27. ~tE OF DEATH I~ D.a., VI'}
<br />
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<br />2811 0", rt SfGNEO fW Od~ ~.:
<br />
<br />1.80 "<IE 00 DEU~
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<br />June 10, 2003
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<br />~~ il .-, 2Be Of! II'\f! bUt$ at e-lIloill't'lll\iOOn oiIIM r)r tl'NeltlgDon In mV QC)Ir\j()f'I Matti occurr(!d .-
<br />! IhP. ""'Ie' ~ and plat:e an.,~ due to N tau&el'8' lItillm
<br />I
<br />
<br />
<br />27b OATE StGflIED (lAD DBv V, I
<br />
<br />/ 5 n.trur8 a. Tltlel
<br />DEATH:' ')1'I,lATIC)N 8H~ CCNsI~AEO"
<br />o UNKNOWN ~ Nt)
<br />31 ""''''E ~ ~ESS Of' CeftflFIEA rPHYSICIAN, CORONER S PHVSICI"N OR CQlJN"tv ATTORNEy T;;pe ar pm,
<br />
<br />30 b W~S CONSfNl GRANlt:O"J
<br />D vi", ~"'O
<br />
<br />Steve Husen
<br />32& ~EGISTRAR
<br />
<br />
<br />Grand Island. NE 68803
<br />
<br />---~~32. OATE'~WJrfrr2 02003
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