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87-- 105257
<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 DEPARI'MW OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR,
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE GL .
<br />AUG 19 17w STANLEY SI;COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL1',ST4tISTICS
<br />STATE OF KIIIASOA -DEM mam OF BEALTH
<br />SUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />N -N AMt - IFIRST MIDDLE LAST
<br />six
<br />DEATH (M.., D.P. TO
<br />Ederar Arnold Rohs
<br />I Male
<br />. August 13 1987
<br />Whit., w AwNN)E.e ORIGIN /DESCENT(e.R., Doi—. Mwk.e.
<br />AGE -Wo 1iebEeT
<br />UNDER I UND t I DAY iDATECK RIRTH(Me.,De,, Tr.)
<br />1.0—. ekj (So* -Wr) GE—E0. ek.)(Spw)Ir)
<br />On.)
<br />i
<br />MOS. DAYS HOURS . MINS.
<br />A. White German
<br />75
<br />w. 6c. I 17.Februaly 1912
<br />AR q "am (M -01. U.S.A., CITIZEN OP WHAT COU N MA
<br />NAME Ot SPOUSE (If ft. R^'e —id" -1
<br />WIDOWED, DIVORCED (Spsilr)
<br />�
<br />New Salem North Dakota E. U.S.A. ,o. Married
<br />11. Blanche M. Husak
<br />SOCIAL RECUEITT NUMISIR USUAL OCCUPATION(Giw tiw♦e! —k revue 4.6.9 NTT 1N/DOPRUSINESSORINDLISTRT
<br />COUNTY Of DEATH
<br />rMe. eree it. 61") P
<br />12. 506 05 9007 13.. Plant Mana er 176.
<br />1«. Hall
<br />CITY, TOWN OR LOCATION OF DEATH
<br />INSIDE C,TY LIMITS
<br />HOSPITAL OR OTHER INSTITUTION lN:rol,e eiMer, IT NOY. Ot INST.IMk•NDOA.
<br />0.". I•b11— r. I.,.N—
<br />(Spw' w er Nel
<br />'`'des
<br />!iw . 1
<br />"rVA"ea`iPcal Center Inpatient
<br />I
<br />Grand Island
<br />, «,
<br />, ,A..
<br />RESIDENCE -STATE
<br />COUNTY
<br />CITY, TOWN OR LOCATION
<br />STREET AND NUMDER
<br />INSIDE CITY LIMITS
<br />„�. Nebraska
<br />,,,. Hall
<br />,,,, Grand Island
<br />,sr.11 ?4 W. 12th Street
<br />(S Tw er ME)
<br />,S.. es
<br />MOTHER
<br />– MODEM NAM FIRST MIUME lA
<br />, (dec.) Jacob Rohs
<br />(dec.) Minnie Weigman
<br />WAS OKEASED lTIN IN U.S. AYAEO FORClS7
<br />INEOtl:IANT- MAW -RELATIONSHIP - MAKING ADDRESS (% MIT OR 11 D. NO.. Cm OR IOWN. STATE. EU)
<br />„Blanche Rohs Wife 1124 W. 12th Grand Island NE 6881
<br />—STATE
<br />Rt1R1AL, [reel.r)en, ReNw.l
<br />CEMETERY CITY OR TOWN
<br />a.-Burial
<br />»b.Au . 15, 1987
<br />»..Greenwood Cemeter »r. York Nebraska
<br />A /
<br />FUNERAL NOME –NAME AND ADDRESS (SIMR 01 R.T.D. NO.. CITY 01 TOWN. STATE, LN) 68801
<br />Y1A fel- Butler - Geddes, 1123 W 2nd St., Grand Island, NE
<br />WAR DIA74 (AM. Dq, 1
<br />(Me. D.P. Tr.l
<br />UR of in
<br />b, ugu t 13, 1987
<br />r� T
<br />«.
<br />:.b. M
<br />DATF 510"19 (M... P. r•1 At"
<br />DEAD
<br />PRONOUNCED DUO (Her.)
<br />r
<br />p` PRONOUNCED
<br />August 17 1987 �a
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<br />(two ONLY Oly CAUSE PEE UN[ O, M, AND (c)) 1, .4 b• _ •.M." rw h
<br />Metastatic adenocarcinoma of lung2 Years
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<br />Now a NYORT atc"I
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