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87--- 106855
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />r DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />I OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTM T.W..HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPP6S1T6RY'F•OR'.
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE �Q[
<br />OCT 30W
<br />STANLEY 6i ; C,00PER 6;1TIRELE`'1'C+R
<br />LINCOLN, NEBRASKA BUREAU OF V1FIip�ST1�I5TICS
<br />STATE OF NEBRASKA— DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATHS
<br />DECEDENT-NAME FIRST MI E LAST
<br />SE %
<br />DA E OF DEATH (Me.. De,, V,)
<br />Wayne Jackson McKimmey
<br />, Male
<br />1Se tember 25, 1987
<br />I ACE -1..q.. WM;N. Elxb, AM«;Eaw OMGINIDES CEHT(•.q., xalien, W.;.ew, AGE -I.x E;rMdeT
<br />UNDER 1 YEAR UNDER I DAY DATE OF WITH 1" Der. Yr.l
<br />Iwl:ew, eTTJ lSPESiF,) OelwrDnr •N 1(Sp «IEYI (Yn.l
<br />THOS. DAYS HOURS • THINS.
<br />.. White ,. Unknown Q �,. 62
<br />,�. ,Jul 10, 1925
<br />I AND STATE Of BIRTH (N wet ;w U.S A.,
<br />CITIZEN OF WHAT COUNTRY MARRIED. NEVER MARRED.
<br />NAME W SIOUS[ (N.iH. 0..n ww;dew weae)
<br />we1.e newT>Y/
<br />q_Sargent, Nebraska
<br />WIDOWED, DIVORCED fSp «;f,)
<br />, U.S.A. ,D Widowed
<br />SOCIAL SECURITY NUMBER
<br />KIND
<br />OF BUSINESS OR INDUSTRY
<br />COUNTY OF 11 AIN
<br />7 505 32 9581
<br />er w «biw
<br />11. �a�iorer 11b
<br />0 0
<br />Construe ion
<br />" Hall
<br />- CITY, TOWN OE LOCATION Of DEATH
<br />IT
<br />INSIDE CITY OMITS
<br />IT
<br />HOSPITAL OR DINE! INSTITUTION - Npre Ilr w.l;w *,the, If HOSE 02 INST I.diul. DOA,
<br />HO
<br />,ab Grand Island
<br />(Sp« or
<br />,4, ryes
<br />/I Iarp w,r�b r) 0.M /I.w1 /lw.r Rn.I.eeu•nr fSlyd,l
<br />,,, �A Mf3dlcal Center ,,. In atient
<br />j RESIDENCE -STATE COUNTY
<br />C15,7 , TOWN ORLOCATION
<br />STREET AND NUMBER
<br />INSIDECITY LIMITS
<br />(Sp..rf Yn
<br />,,..Nebraska ,%. Hall
<br />Grand Island
<br />,3d 1611 N. Wheeler
<br />,s• lies _
<br />FATIffl-NAMIL 1IFFIT MIDDLE LAST MOTHER - MAIDEN NAME FIR5T MIDDLE LA
<br />(dec.) Ralph William McKimmey 17(dec.) Edna L. Parker
<br />WAS DECEASED EVER IN LV& AWED FORCES? INFORMANT -NAME - RELAr10NSN1P - MAILING ADDRESS ISTRIT OR . .I D NO. CIM1 OF 10W.1. -1]. 1-11
<br />nr.. u x s a.1.. 1 1
<br />IN '1171.6-21-, 1 -26 -46 i„ William Mc_Kimmey Brother, Box 252, Kenesaw, NE 68956
<br />SURIAt, Cr.w•6err, R.r.e.el DAT CEMETERY OR CREMATORY - NAME
<br />LOCATION CITY OR TOWN STATE
<br />2". Burial _ 9 7 120.Parkview CemnIF]ry
<br />7fJd. Hastings. Nebraska _
<br />E SLATER -51G i RE R l
<br />S NO. fUNERAI HOME -NAME AND 19 SS (STREET OR 11.10 NO. CITY OR TOWN. STATC ZIP'
<br />Livingston - Butler - Volland Funeral Home, 1225 N. Elm,
<br />7 .
<br />177. P.O. B
<br />DATE Of DEATH (Me.. , Yr i } DATE SIG DlMe. Da,, Y..1 INOVR LlF DEATH
<br />73a September , I9 y y 7dD. ?ab_ ,H
<br />2yi
<br />3Y DA IGNED IMP_ DoI, Y.J HOUR Of DEATH :iI FROHOUNCEDDEAD fEONOUHCED DEAD 111-1
<br />t' (Ma., D.Y. Yr.l
<br />September 23, 298 6:40 a . %
<br />r� 71A. „ M 749
<br />\ j T• iete aer.nn..a n/.../ar" w., »� ��. o. M. s.u. a •.wwiw.w..rJf•r :w=-ITT •w ' wI eew- N.M ....... m
<br />1111 rr.•. MN s.1 II «. e.d M .1 x..w1.1x rn+N
<br />� ,/ / II
<br />r� -"LA
<br />J1J,fs;r..r•r..d T:x•I �' G� lAR. f5iq.e/.1. e.1 T�M•I
<br />NAME ANO AOWESS M CERIIf/ER fPNYSICIAN, CORONER'S PHYSICIAN OR COUNTY AITORNET) IIYp1 01 Prrwl/
<br />Leticia M. Pinto M.D., VA Medical Center 2201 N. Broadwell Grand - Island NE 68803
<br />REWSTRAI —' n DATE RECEIVED 11Y REGISTRAR (Mo., Day, Yr.)
<br />1 1887
<br />:ee.rs R•..n,► �� eftg xab. OCT
<br />77. IMMEDIATE CAUSE (MIER ONl E CAUSE PER LI FOR (.k (b). AND (U) I. 1 b•rw•. «r.1..d MM
<br />P`w Metastatic carcinoma to liver and brain 3 Months
<br />;
<br />DUE 70. OR AS A CONSEQUENCE OF: .Nra.l b...... --..A d-,
<br />Adenocarcinoma of the lungs 2 Years
<br />DUE TO, OR AS A CONSEQUENCE OF: F NN.wI b•rw•. ...R end d.sA
<br />a
<br />PART • Swl••IKMH COINITIOHS- C•rNaw. ""barvy .1 e..M ■.r war .alaM rAR Ix 111 -.. w ; 1 EeNA AVTOISY
<br />MEO>uNCY E IA3 lMp 1N]> (]ar. /, >r r Nal
<br />WAS CA)2 RE SINNED 1 . Me[xCAI
<br />!%AIYNEE OE COpM[1
<br />H
<br />ASHD; degenerative No
<br />(SP $t Yu •r N.,
<br />arthritis Yee E Ne ; 7R
<br />7Y O
<br />AeerTH1.1, lVeDol. N0VTTVT . Iw+DeT . a1. p w. _ TM D.r. >,.I
<br />�• a Iw�er uscaeE
<br />ND•r 1— —Ee,D
<br />p 12.10.1.0 VNVV%1IOA1 ISIw.I11
<br />3M. 30b.
<br />1.k. M 30d.
<br />RUURr AT WORK
<br />NAtf OF INJURY At b•ere, fe/er, x1..1. T -7.
<br />IOCATx3N STREE1 Olt F D Me CITY OR TOWN STATE
<br />(I-" re. « Net
<br />M61. bw11M. e1. fSM[;111
<br />The Northerly Forty -Six Feet (N46') of Lot Six (6), in
<br />Block Eighty -Seven (87), Wheeler & Bennett's Fourth
<br />Addition to the City of Grand Island, Hall County,
<br />Nebraska, known as 1611 North Wheeler Street, Grand
<br />Island, Hall County, Nebraska.
<br />0
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