|
I
<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 DEPMTORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />NOV 2 4 1987 TANLE
<br />STANLEY-S.- COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF.NITAL STATISTICS
<br />87-- 1G6939
<br />STATE OF *EARASKA -WMTMW OF HEALTH
<br />SURM Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />CE NT -NAME FIRST MIDDLE
<br />ER
<br />OA E OF DEA N (Me., 0e,, Yr.)
<br />1. Oral Da ne Gilpin
<br />12 Male
<br />3,November 11 1987
<br />RACE - (eel.. Whife, Rl.Ck Awefken ORIGINMESCE"T(e. R.,N.Iien,Me.kee, AGf -M. B.""'
<br />UND[t 1 YEAR UNDE! 1 DAY DATE Of 911TH (Me DeY, Yr.)
<br />IeTFNe. ee,j ISperdy) Oerere,.)(S -14 pb (Y«.)
<br />MOS. DAIS HOURS. MIHS.
<br />.. White s. American w. 73
<br />w. «. ?.June 26 1914
<br />CITY AND STATE Of RAITN fM eat in U.S.• , CITIZEN 01-- COUNTRY MAtRI[ NEVER MARRIED,
<br />NAME Of SPOUSE (IF .00. pin w.id.. Iww/
<br />11 WIDOWED. INVOKED(Sperifyi
<br />I,pw Ni1
<br />F.
<br />Ytl
<br />R.Dunne an Missouri ►. U.S.A. Married
<br />II.Lillian M. Williams
<br />SOCIAL SECURITY NUMBER USUAL OCCU►ATION (Gin kid nl.e.1 deee d.rinp wed RIND Of BUSINESS OR INDUSTRY
<br />COUNTY OF DEATH
<br />.r- • <unRUE.••nndo eir•d) S. Postal Se
<br />I
<br />e
<br />1x506 -09 -5065 Ise Su erintendent of Mails Iub.
<br />I", Hall
<br />CITY, TOWN OR LOCATION OF DEATH
<br />INSIDE CITY LIMITS
<br />NOSPIT11l OR OTHER INSTITUTION - New OT -_.fm in silher, H NOV Of INSI i;ZeH, DOA.
<br />OvMlc.« /leer V . lwl.newl fS.wdy)
<br />144 Grand Island
<br />(Sp-if, Yes W NN
<br />1.r.Yes
<br />pin FFnN end evelMfl
<br />1.Ed, 1418 N. Huston I" - - --
<br />RESIDENCE -STATE COUNT'
<br />CITY. TOWN OR LOCATION
<br />STREET AND NUM11.
<br />INSIDE CITY 1IM175
<br />(Sp.ri Yet er NO)
<br />Is.. Nebraska 1s. Hall
<br />Ix. Grand Island
<br />Isd. 1418 N. Huston
<br />Is.. es _
<br />A _00it LAST
<br />MOTHER - MAIDEN NAME FIRST MI U
<br />1. Elvie Guy Gil in I
<br />17. Elsie Pearl Lewis
<br />WAS DECEASED EVER IN U.S. ARMED FORCES?
<br />INFORMANT- NAME - RELATIONSHIP - MAILING ADDRESS (STEEIt Of 110 NO.. CITY OR TOWN. STATE. MIT
<br />Is. No
<br />I ►.Lillian M. Gilpin-Wife-1418 N. Huston -Grand s and NE
<br />BURIAL. C<ewfien, R«esnl
<br />CEMETERY OR CREMATORY- NAME
<br />LOCATION CITY OR TOWH STATE
<br />».. Burial
<br />Nov. 14, 1987
<br />]a.
<br />xa.Westlawn Memorial Park
<br />..'Grand Island NE.
<br />1
<br />SIGMA, 1 �fJ
<br />FUNERAL HOME -NAME AND ADDRESS (51.11 M !.I D NO. un M t . STATE. Z111
<br />])
<br />A fel- Butler- Geddes 1123 W. 2nd, Grand Island, NE.68801
<br />DA
<br />E SIGNED (Me. Dot, Yr.)
<br />HOUR 01 DEATH
<br />a5
<br />�
<br />a"
<br />71b. M
<br />]b.
<br />j} i PRONOUNCED
<br />D.F. Yr.) HOUR OF DEATH
<br />DEAD
<br />PRONOUNCED DEADIM —)
<br />"� x5..
<br />M Via] 2«.
<br />/
<br />i
<br />To e. ►fff M ev L•••Iedf.. deeTh .N NI 01 'he �e MN .M PI «e e. de. M 1M
<br />i V O.
<br />dl. IT". N «..i.eriw M/er i.wfFfefM, i. N, eea ._ «.Fh « "ed N
<br /><e.fN,l.MfN.
<br />. the
<br />`
<br /><Iw
<br />li.. deN aM PM<e ewd d.. w r. <ww(J d
<br />] .ISN••�.. •
<br />71e.ISip.N.w
<br />eM T;..) be
<br />IMMf MIER (PHYSICIAN. CORONER'S PHYSICIAN OR COUNTY ATTORNEY) (Type er P,mt)
<br />David L. Howe M.D. Hastings Medical Park, 2115 N. Kansas, Hastings, NE. 68901
<br />No STtAR
<br />DATE RECEIVED RY tEGISTlAR (Me., Do,, Yr.1
<br />]M.(A!ALM nl.
<br />xeb. N O V 24 1887
<br />] IMMEDMTE CAUSE (ENTER ONLY O AUSE PER LINE f (o), (b), AND (r)) M<.rwl ►.I..ew w.w .M drr
<br />►A!T f
<br />or
<br />DUE 10, W AS A CON ENCE Of: --I b.Ne«...N .w1 d «M
<br />(.I i7�c �. , -r��a -ice. Yy1 yr11 _
<br />DUE TO, Olt AS A CONSEQUENCE Of: I.—I bN.e.w .a.f .M deer
<br />IT)
<br />;.IT
<br />►ART HER SIGNHICANI CONDITIONS C"" * rrm ►vHwf N dwr Wf .« a.N IAf1
<br />1.. H FEMME. WAS THEIR A AUtOIS1
<br />IN THE PAST S MONTHS, 13—st, 1« « WI
<br />AS CASE MFNHD TO MEDICAL
<br />EfAMINEf on CORONEt
<br />ACCIDENT, IRACIDE. NOMKIOl, UNDEt. DAIS OF INJUf1(W., De,. Fr.)
<br />HOUR Of IWun DESCeIpI
<br />NOW IFMUe1 OCCUHID
<br />OD P1NOM1f NfYlStIGATfON ISPwA,I
<br />70.. ]Rb.
<br />70r M ]Ode
<br />MUYf1 Al WOER
<br />PLACI OI Nr1UfP— M hew.• I.r.. <fr.er. Iwlery,
<br />LfXATgN SItlET OA e F p. w CITY p tOwN $LAIN
<br />fS,NN,FY Iwr FN)
<br />"k. ►eiNiwf,
<br />]R..
<br />7a.
<br />a
<br />0
<br />
|