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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOWTO .if -A;TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE D$T OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL 'D11R'OS Y FOR
<br />VITAL RECORDS. "
<br />0
<br />O DATE OF ISSUANCE
<br />JUL 31IM
<br />STANLEY'S,..COOP$ IRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF," TAL STATISTICS
<br />STATE OF NEBRASKA - NVARTNENT OF NEAITN
<br />NNIEAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />-N' FIDS E LAST I SRI DATE DEATH fw .
<br />LINDA MABEL WIESE ` FEMALE 1,, July 27 1986
<br />RACE Rl..tt Mw:FM ORIGMJOtxEM I• b l:.., M«ieM. AGE -Ir. a w.. YNDER 1 1" UNDER 1 DAY DATE d RNTM (M...
<br />I.I:w..ICJ(S/.•a•) C...I....N.,rtw..:1,/ ; (� rn,.I MOS. DAYS "Out$ - mon
<br />• White American U �.- 85 a ,,January 20, 1901
<br />ATEd RUIN 111 -1:. Y.S.A.. C1li2EN dvW1AT COUNIR'I NIVER �NAMEd SM115E fM�./.�..w;f,www�!
<br />..r.1 I) WIDOWED, w=rDfSI«ifr'1
<br />R. Rural Hall Count Ne -.,- U.S.A. ,D.Widowed I „Arthur Wiese (dec)
<br />SOCIAL SECUM” NUMRp UwAt OCCU►•T,ON (G:.. F:wJ.f.wri r... I.riq .,..1 [Nip s US,-- OR INDLISTR COUIM d OtATN
<br />12 507 -26 -2619 �.«t:.,rr.- ....:1.«..rl
<br />,a Homemaker „`Own Home „� Hall
<br />CITY, TOWN OR LOCATION OF DEATH INSIDE CT IMYTS NOSMAL OR OTHER INSTITUTION - N.r. fff.N: w Not, Ot INSi I./4.w OoA.
<br />fSw.c:(FY.1w N.1 ,OwspStAL.Oeor inRIcH 1,../.I�. er, Room
<br />rSwrA,l
<br />,.� Grand Island, Nebraska ,... Yes ,R,I.St. Francis Medical Center j,.. Emer: Room
<br />RESIDENCE -STATE COUNTY I CITY, TOWN OR LOCATION STREET AND NUMBER I INSIDE CITY !WAITS
<br />,-.N %
<br />ebraska ,. Hall !mGrand Island Tsa. RR # 1 Box 315 A f; `' "{{oN''
<br />A - M, MOTHER- MAIDEN — FIRST LAST --
<br />Charles ----- Boltz �i7 Anna ----- Boersen
<br />WAS DKEAM EYE! NY U.S. Alp" FORCES? INfORMANT- NAME - RELATIONSHIP - MA,UNG ADDRESS ISTWIT of ■ T D NO. CRT d Tow STATE 2m
<br />IR. No N%A -19 _Vermoyne Wiese- son -Rt.1 Box 315A,Grand Island, e.
<br />BURIAL Cnn.eT:... j CEMETERY Olt CWJ*ATORT - NAME ZOCAT,ON CITY OR TOWN STATE
<br />x.. Burial ..July 30, 19861». Grand island City Cemeteryl2w. Grand Island, Nebraska
<br />M%;�e,Y UNERAL (STIRR p EI D. Np., [�T• W TLri.N ST•TE. Zw) iv 68gge .
<br />_� =zi' ingston- Sondermann,505 W. Koenig,Grand Island, Ne.
<br />U z�j Li - - --
<br />1O iK.
<br />` - (•M.. ITHOUR of DEATH —.� �C PRONOUNCED DEAD I M
<br />.PRONOUNCED DEAD (H.w)
<br />i Z-►. 27 • n-..
<br />7-22 M it;
<br />.�r.�.wwr.lai�' "'. "'. •.'..,pw./ "'r s"`,�I m' S�� a w» sr. M «..�..... w ..wy. �. +..+:» •..w �.,..r r
<br />w
<br />rsy.r.. w rwI ► i
<br />(PHYSLCLAN. CONONWS PHYSICIAN a COUNTY ATTORNEI) fTIP, « PrrM1
<br />Dr. Marlin Bauhard,S r cis di &al Center,(Emer.Room) Grand Island, Ne. 68801
<br />REGTSYtAR ,DATE RECEIVED RY Rtcarw IM...
<br />JUL 31 1986
<br />/ (ENTER Ow E CAUSE PER LINE FOR (.). fY), AND (cJJ
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<br />Zo,
<br />DUES JIE A CONStWENCE p: i
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<br />K /"tOnAry (, dCFh� J
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<br />DUE TO, OI,AE L CONSEQUENCE d: —../ 4-A _.
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