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87-w -r -100345
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA' STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO'BE A TR#R COPY
<br />OF AN ORIGINAL. RECORD ON FILE WITH THE STATE MAR .4 11EALTI
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITOR? FOR
<br />VITAL RECORDS.
<br />Zu
<br />DATE OF ISSUANCE Ad
<br />JAY n O yti•� STANLEY $6
<br />CAAPFR" ?RECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL. STATISTICS
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />DECEDENT -NAME FIRST IA +DDIE� LAST T _ DATE Of DEATH (M. , De,. Y• I
<br />Walter _Y.ezrann Meinke 2 male Lo December 23� 1986
<br />MCE -U.p, WAilm, ►lot E. Arw «Ken
<br />DESCENT(. q . Nol:o ^. w..K.n. AGE - — I.. L UNDER T_TEAR UNDER I DAY i DATE Of BIRTH (MO, DoT, Y1 )
<br />.K Ilse «A, / �(rr•) MOS DAYS( HOURS: MINS
<br />white s German a 73 (eb 'e iT December 9e 19
<br />CITY AND STATE OF BIRTH (M rot .n U S.A . jCITIZt" Of WHAT COUNTRY'. MARRIED. NEVER ALAlNED, I NAME Df S►OUS[ (1E .d., p•.. •A.n �nm/
<br />,;WIDOWED. DIVORCED(Sp «fy)
<br />IHoward County Nebraska I9 U.S.A._ otdarried u L
<br />SOCIM SECURITY NUMBER USUAL OCCUPA710N (G.•. L.nd el.orl den. denw9 SIND OF BUSINESS OR INDUSTRY 1COU.TY OT DEATH
<br />554-
<br />TS -6100 la. Brewer
<br />x_,36 Falstaff Brewery,d,Hall
<br />_
<br />CITY, TOWN OR LOCATION OF DEATH INSIDE CITY LIMITS "i HOSPITAL OR OTHER INSTITUTION- H.— (I( ."A. OS. OR rNSF IM:I.h OOA.
<br />/SP«I(I Y.r e•N.l ,9••. Fr A^ b«I %O.roer:.w /itr•Pn.I +er.• ^rrS.W d,I
<br />db
<br />Grand Island k yes dd JAr??edical Center inpatient
<br />RESIDENCE -STATE :COUNTY : CITY. TOWN OR LOCATION STREET AND NVMBE■ 'INSIDE UTY IIMiTS
<br />rsGa<r;e S• a• Na)
<br />se Nebraska i,sb Hall ;,h Grand Island Ise 2316 W John ;,s. S _
<br />AHE -NAM I MIOTkE L•.51 MOTHER- MAIOCN NAME FIRST MIDDLE LA511
<br />Tuerqe
<br />76.
<br />(dec) Fritz William Meinke „ (dec) Martha H.
<br />WAS DECEASED MR IN U.5. ARMED FORCES? INF a AME - RELATIONSHIP - MAILING ADDRESS IST.,11 OR P 10 NO. CITY M TOWN, STATE, ZIP)
<br />,weswWWkI1'%1 -5- 37/3 -9 -43' p Mrs. Lucille Meinke,2316 W John, Grand Island, NE
<br />BURIAL. Cr.Merron, R.W...I BAT CEMETERYORC REMATORY -NAME -- 'ICKATION CITY OE TOWN STALE
<br />Dec. 26, 1986 Omaha, Nebraska
<br />29, B rial 'pb Sor Hillcrest Cemetery Sod
<br />EMBA NGNAT E NO ? '� FUNERAL HOME -NAMf AND ADDRESS (STMT OP P.1 D NO. CIF/ OE TOWN, SFATC 21M
<br />:T J `12,Apfel- Butler- Geddes 1123 W. 2nd, Grand Island, NE.68601
<br />( DATE SIGNS (Me. D.,, Yr.) (HOUR Of DEATH
<br />A< 2
<br />'1986 ��i
<br />y X23.. _o L2Aa. 1�6. M
<br />• DATE SIGN D (Mm . D." Tr) jHOUR OF DEATH i i I PRONOUNCED DEAD PRONOUNCED DEAD (H0
<br />2Sb December 3.1L_1986'�SS< 3:27 _a. A2 S''2.r.
<br />i Ti rb. MM ♦ q Mm'•1•dB•. l..M w <.•••d a •M h.r. .M I wd M! i �j O On M. 1w , ./ •wn�^sr:•w end /w •^wmiRsrisw :^ w, piwi.w MmM .<r... Nf n
<br />= ` � <.•••fal ..I.d .�- /,I / /a�./+� p � �y�fy. a FO , M• nom,. deH .M .I «. e^a d.• + M• ae.Nld <hNd
<br />27d.rsy ✓•�..^I r.Na �)( kuw2/" �"`"' ' i 7h. IL:R.e..v ena Te•I
<br />N14I1E AND S ER IFIft (PHYSICIAN. CORONEtS PHYSICIAN OR COUNTY ATTORNEY) (11P..1 P'I )
<br />;,Daniel R. Pestal M. . VA Medical Centers 2201 N. Broadwell, Grand Island, NE 68802
<br />tEWSttAR DATE REC7% /Y REGISTRAR (MO., O. T. YI.)
<br />yT •J//�ry sI
<br />26b
<br />7T (MME qA CAUSE (ENTER ONLY !CAUSE PER LINE OR 'TT, , (b), AND (rl)
<br />Minutes
<br />., CardaI, pulmonary failure____________________
<br />E O, ON AS A CONSEQUENCE OF: I b•M.^ «•.r a ^d dwM
<br />IT,, Pneumonia Approx. 36 HourE
<br />. —_ -- --- --� Iwhml b.ox 2 mwd d
<br />DUE TO, OR AS A CONSEQUENCE OF
<br />- _- - -� -_- ��_ - -_
<br />W I,un� carcinoma ___ _, ___ _ _._ _ _ __ "_ A rox. 18 Montl
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