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<br />. #
<br />WHEN THIS C~Y CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSJE'Af, "CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL SECORD oN FILE WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA TlfTiCS'S'Eiit'JiiR.''WiIICH IS
<br />
<br />
<br />:TELE;:::TORYFORWT;;~;;67 50 fi.1;~"
<br />
<br />AUG 3 0 2001 A.'#~NTSTATE tiG
<br />LINCOLN, NEBRASKA HEAL TH ANlitfUI.IAN -
<br />STATEOFNEBRASKA.DEPARTMENTOFHEALThANO~ERVlI' PORT
<br />VITAL STATISTICS, ._=:;= () 1
<br />CERTIFICATE OF DEATH:. ._,~..
<br />: .'. ".r':'.'~:.'.~l'-;"~DA-{('or-o[-Ai.H'/Ml)l)th (\1\ ~;;;;::-_.,--'---_.._----,.
<br />6
<br />st+. 2001..
<br />
<br />...
<br />-.
<br />
<br />
<br />J ".".' \ ,) 1
<br />I ., t
<br />\._ ...; l.l (_ _.
<br />
<br />,---- MIOo'i:i~ .-----~.-yi~AS'T
<br />
<br />2. S~X
<br />
<br />. . I .~ ,Ul.N !
<br />
<br />N/I,ML
<br />
<br />f 'IH~j 1
<br />
<br />Viola
<br />
<br />IX>ris
<br />
<br />Morris
<br />c:a AGE ~ Lasl!3ll1hdav UNDER 1 YE.AR ~~
<br />(Yrs I ~b MOS DAYS
<br />75
<br />ail. PlACl::. C)~ DEA n.l
<br />
<br />Female
<br />
<br />
<br />1926
<br />
<br />-I (;ITy ANO 'STATE OF BlnTH
<br />
<br />IftnotiiiUSA~""""n~'ry!
<br />
<br />UNDER I DAY
<br />5c HOURS MINS
<br />
<br />Syracuse, Nebraska
<br />;:,CiCIAl ~-)t:ClJHTlY NlJMA~,H
<br />
<br />12459 W. Burmood Road
<br />
<br />HOSPITAL 0 lr"1pa\lenl OTHPR 0 NU(5ImJ Hom~
<br /> 0 ER Outpatienl OCJ Hp.!:ilrl~nc~
<br /> 0 nOA 0 01hf;!r tSpp.ofy'
<br />
<br />508-28~6833
<br />
<br />8b j: ACIl, I T Y - Nil.rn~ (It not msfllutlort, givs S/,.88! and number)
<br />
<br />F.
<br />
<br />
<br />Bd INSIDE CITY LIMITS
<br />
<br />~".,-,'--,._---_._,.,_.,-,,_.
<br />COUNTY OF- UEATH
<br />
<br />ik .:11' I '.)WN OH lOCA! ION or oEi\.fi~
<br />
<br />wood Ri vcr
<br />
<br />Yes 0 No
<br />
<br />Nebraska
<br />
<br />lOb COuNTy
<br />
<br />......~~ll
<br />>-lAU,: . (e,q.. Whlt~. BI8.cli AII1('(lcan Indli\r1
<br />
<br />11 ANCESTRY le.g lIallan, Mell:lcan, German, otcl
<br />[Sp8GlrYl German
<br />
<br />W. Burrrxxx.'J Rd. ,Ye' 0 Nu [Xl
<br />
<br />o wmOWEO--l:-NAME OF SPOUSe II: w,/.- Q'",' m,,,,1en ~_'-;;'e!
<br />
<br />o ~V(~HCW . _Rex Morrls ____
<br />
<br />1:) EDuCATION ISP~.9_''!y.?~I,'C~9hest gr;H1p. !:()fI\pl~li::'d)
<br />Etenll:!r1li::lry Dr Secundary 10,121 COI,:;"ll II ()I ~I'
<br />I
<br />17 MO'.fH(.R ----~.~--- FIRST MID!)l F MA([)(N'SURNAME
<br />
<br />9;, ~FSIO~NCE - StATf::
<br />
<br />! 10
<br />
<br />"Ie IISOCWhi te
<br />
<br />1 i\i1 '.J::iUAl OCCuPA nON IG,ve kind of w()r!r: done dlmng mO.';I1 140
<br />of wm!r:mq life, eVElf! If r~t!redl
<br />Bookkeeper
<br />-16-rA"THER -~NAME FIRST MIDDLE
<br />
<br />William
<br />
<br />Rebecca
<br />
<br />Rippe
<br />
<br />. NA-t.:1f.:
<br />
<br />!~.-'~~!'^S DECE^SED FVFR IN \J,S ARMEll ~'ORCt.S"
<br />'{e!;> q(! m lInK,1 II! y~:~:, ('j've wJ.f and oates of servicesl
<br />I No
<br />1".' 1.~;;--:NFonMANT MAIL~I-"iG .ADDRESS
<br />
<br />I 12459 W. Burmood Road
<br />i'i:O-"M8A'G~" ~C1NS['NO
<br />I .--- .
<br />i n,l CUNFRAl HOM~ . NAMf:
<br />
<br />
<br />/21/(/
<br />
<br />wood River, NE
<br />2,. MtTHOOi'ToISPOSllIO' .
<br />
<br />68883
<br />
<br />~urial
<br />
<br />o RemOvil'
<br />
<br />121b DATE 21c C~M[f[RY OR CREMATony NAM~
<br />
<br />1210 ~~~T?!v ~R1CRbMA'OHY LlCATH~estla~y ~:tery
<br />
<br />STAT[
<br />
<br />Apfel Funeral Home
<br />??h HJNtRAL.HOM(ADo"RESS- ISTREf.T OR RF.D, NO.. CITY OR lOWN, 5T ATE, ZIP)
<br />
<br />o Cremation 0 Don,)!I!)'. I
<br />
<br />Grand Island,
<br />
<br />NE
<br />
<br />411 West 11th St.
<br />
<br />p.O.
<br />
<br />Box 1 26 Wood River,
<br />(tNTEJ=! ONLY ONE CAuSE PER LINE FOR 1;:11 Ib), AND (ell
<br />
<br />NE
<br />
<br />68883
<br />
<br />n IMMEDIATE CAUSl::.
<br />PMH
<br />1
<br />
<br />In(f>rV;jl betwecn ons.et "nr: (lP.:~n'
<br />
<br />1;:1.1
<br />
<br />Natural causes
<br />ouE r6'OR AS A CONSeOUENCE OF
<br />
<br />un~nmvn.
<br />Inlcrv,l elween onsp.l il.l10 i1!!illt'
<br />
<br />(bl
<br />~--- rll~JF .r-n'. nn AS A r;ONSFOUENCE or-
<br />
<br />
<br />~C.~THER-SIGNIFICANT CONDITIONS. CoMitlof'ls contributing to Ine death but nol related
<br />PART
<br />"
<br />
<br />\ -..-----.,.-
<br />
<br />'1~.6,.~." 0
<br />I" ACCldenl Un(\f!tp'rrllllllJd
<br />i I~ -)IJICld!::! [J PCnrJ1flg
<br />
<br />Intp.rv,,1 nf!IWf!en onset ;-lnd (11','111\
<br />
<br />I ~-
<br />ii~
<br />I
<br />J
<br />
<br />'~lJfTllCldc
<br />
<br />IflVC51nJilotlon
<br />
<br />Yes 0 No 0
<br />
<br />
<br />2~ WAS CASF REF-!:.RRCD 1'0 MEDICAl
<br />EXAMINER OR conONFR'J
<br />Yes Kl No [j
<br />
<br />260 DATE OF INJURY IMo a.y. Yt.)
<br />
<br />26c, !'-lOuR OF INJURY'
<br />
<br />26e IN,JURY AT WORK
<br />
<br />2Qq. LOCATION
<br />
<br />STRE:.E: TOR H,F D, NO
<br />
<br />CITy OR TOWN
<br />
<br />Sf A IL
<br />
<br />I ?7~'-.'I')A lE.C)F O~A Hi IMo Day Yr.)
<br />
<br />
<br />~ :i I <7b n,,--;:'E'SliiNEO- 1M" O,y Y.,)
<br />'H~L
<br />
<br />'~t 1 >7rlT;;I';~;;~;'-;;;;O. v i<.r""lOwlt'dqe oeath o<::c\Jrred al the ti;~:',-datp. i:lnd IJIi!ce and due to the
<br />p. c\'I.\Jsf!l:;i :=;L':llp.d
<br />
<br />I -1, "IS'!T.~~~~._"__".'~__'~"'_"""."'__'__=_~~~^' J__
<br />I '.:) :)10 ['()BACCO use CONTRIRlJTE:. TO I Ht: OE:A T H? 30 a HAS OR.GAN OR TISSUE: DONA nON BCEN CONSIDERED',
<br />
<br />l. 0 YES 0 NO []J UNKNOWN _ _ D \ES 00 NO
<br />
<br />I j1 NAMC'. AND AOORFSS Of (;f::H11F"I[R lPHYSICIAN, CORONER'S PHYSICIAN OR COUNTY A1TORN[YI iTvoe or Pflnti
<br />
<br />
<br />I peput:Y.--,-~._~:i:G10!:!~gn
<br />r-32a qf.GISTRAH
<br />
<br />"2S;-OA-,"E SIGNED (Mo" Day Yi I
<br />
<br />f? - /3- ~., OG I
<br />
<br />28b l!M~ Of-lJlA1H
<br />
<br />28c PRONOUNCED DEAD !Mo Day. Yr I
<br />
<br />11: 30 PD.M
<br />26d. PRONOUNCr::.O DEAD (Hour'!
<br />
<br />27c TIME OF DEATH
<br />
<br />':~ ii'
<br />l[g>-
<br />~ II);:: Z
<br />(5 CI:: I- 0
<br />;!:~~
<br />,0 R 8
<br />;.:,
<br />
<br />August
<br />
<br />2:15
<br />
<br />a ill..... M
<br />
<br />M
<br />
<br />
<br />n, In my OpH11(Jf) (j!!,J(ll occurred at
<br />d du~ lu 1M cau 51 stated
<br />~.Y._ ........:.- i?'lJ"7"_'-L.l.!"?/,H
<br />30,b WAS CONSENT GRAN 1 CD';> f
<br />D yES ex NO
<br />
<br />
<br />s
<br />
<br />La cus t->-__. Gr an d
<br />
<br />
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