Laserfiche WebLink
k <br />4 <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY tOR - <br />VITAL RECORDS. <br />87-101570 <br />0 <br />DATE OF ISSUANCE '/ ' <br />1 2 W STANLEY S. COOPER, DIJWTOR <br />LINCOLN, NEBRASKA - BUREAU OF VITAA BTAMTICS -� <br />STATE OF NEORASKA- DEPARTMENT OF HEALTH <br />WREAU OF VITAL STATISTICS <br />CERTIFICATE OF DEATH_ <br />DECEDENT -NIWE AEST ISO DATE OF DEATH (AA . O.I, VI.) - <br />, Genevieve Mable Koffke Fesmalh February 28, 1987 <br />PACE- (..y., WAi1.. A, Ar.k,. OtlGUyDESCENT b.E.. Md:s.. At.. AGE- I.,+WM,I UIOE! in" UAIDR i par DATt OP RIRTM(M... D.r -r.J <br />I.w:,...4j(So -or) G..,.,ee,) .rxp a...) ro: DAIS HOURS. MR7S. November 15, 1908 <br />White American w. 78 6. 1,. <br />November <br />CITY AND STATf Of BIRTH (M ... t. U.S.A. ) CITHEN MN OF WHAT COUNT" . NE MAtl SE (ED. NAME OF SPOU (x-ft. <br />1 WIDOWED. DrrORCfD(Sp-dr) t <br />ECarmeI tovnshipMiO"aio U.S.A. to Married Irr, Clark Koffke <br />SOCW MCURHT MDYE! USUAL yOqCCUTAtION (G:.. ki./.(...L M 1•+r�R "•w O<RilAr055O[ INDUAlr COUNTr m DEATH <br />12 376 -14 -6241 1],LerYc typist, Wash. D. C. ��gugS�d Hall <br />CITY. TOWN of IoutIGN GI DEATH INSroe cm Luun rgSNTAL W ot,l@ watinUTrO,) _..... tx-r:. «Mr. <br />. MDY. w.0""-00' <br />(SRrJIrwrMN pr w...rM..ir <br />,r Grand Island NE IAI.Yes Ta.GraMd Island Memorial ,.,, Inpatient <br />RESpENCE -STATE COUNTY C/rr.TOWNORLOCATION slowANO M{WRU - RMSME CGrlYYR <br />tS�d. rsr.�tN <br />I s.. Nebraska ISY. Hall Ix. Grand Island ISa 2125 W. 13 <br />A _ 1151 Ahlom LAW <br />1 Marshall Kell Cora Belle Case <br />WAS DECEASED "m M U.S. AWED PORCEST 1Nt04MMt- NAME- lttAtg2NS,s- MARlSG AODR[SS (A!R Ol tl s ,rD_ tli+ YA2 DPI <br />u. No I IP Clark F. Koffke (husband) 2126 W. 13 Grand Is , Ne <br />EutlAI C....r...Rr.,Mi CEM[TER7 ORCRE,IATORr -NA/,E EOCATIOM Cm N covoW STATE <br />x.. Burial m March 6,1987 2&_Mapel Hill Cemetery 2,�Charlotte, Michigan <br />-Slam i MO. FUNERAL HOME- NAME AM ADDRESS awn" OR U? rp., Cm of WeIH. SPA,! I" <br />Livingston-Sondermann, 505 West Koenig, Grand Islaad,NE <br />tE OF DEATH fm., . r..e (Ala be,. r..) HoOk OF OEM" <br />February 28, 1987 `2v. 2.► ,. <br />ra PRONOIMKW DEAD rROE(o(n+CED OEAD(Fl..d <br />r ! <br />DATE SIGNED` 0". )rnA <br />3-5-$7 2k_ 4 9 P.M. <br />_ s�l�r1. [.'.�F �✓r w.M../.�MArr V.wW r�.a <br />' _rs,...�..r RMN I• r I 2AarSy..., +.r rwr► <br />C COON" ATTOb,Eq <br />J. V. REISS, M.D., P.O. BOX 550 Grand Island HE 68802 <br />0. a ql 041E RECESM® w REGGIISTRAR (Me- Del, r..1 <br />(FAIM OMW ONE CAUSE FIR WN I= (,1(161 AND OM A.wriArr..rr,r► Ar► <br />Pali <br />Myocardial Infarction <br />DUE A Em: A,r..iSr..r rnrrw l..4 <br />d Lon Ntory of Congestive Heart Failure <br />OUF r0. OR AS A CONSEQUENCE m <br />S- .—I V T.Lm . : —TO.S+ r.i CA,e MTelD q MWITAI <br />THE MST,' M—eem ON CoRDNiR <br />u T., G N 2 i zt NO ?t+_ NO <br />KOM.F, fi1ICr0E. rR1,ICiR. UlrRil , 7 6AJS m MleMi N►. Dn. +, t - �+.01M O! eYIM! CESCiE! MOM �YW+ OCtu� <br />fM r6.RM4 MI+ffIrQ� rS..dN i <br />(S,+.RN <br />S, <br />Z <br />-I <br />w <br />