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<br />BLJFfAU t;F ,TAL SIATIS71CS �C 102272
<br />CERTIFICATE OF DEATH
<br />DLCLDENt -NAAfE flBSi
<br />Ruth . Tomlinson ffanale �7 Jnn_ u �_1�8� __
<br />RACE- (.B,WMit..Bls[Y,Ar•t.wTOtK+ IRIDESCENT !• 9. h.,;... W.wM�.GF- ,.+s,wdwrT VNDfF1YFAR1 �liNDERi�DA1EOf{tEMIMe,Dw[.T. -
<br />fnI %.•, .f..)(SO-4y) jG.rew. rH >!S ►..dN �l�fTnl rMOi. DAY SI'NOUIS WNS
<br />s White is -- American y67__ w - -`` TML%Y Q' 1917
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<br />Ciff-A—Mb STATE OT BIRTH (Y... N U S.A . IGITIZw Of WHAT COUNTRY, WARNED. %[VFR MAERILD. Of SWllif (M rA•, yw w..d•. +.e.w.)
<br />MM T1MMY,1 ;WIDOWED. DIYOKED f SP•.ifri
<br />ET Page„ Nebraska_ t U.S.A. poMarried �1I Walter D. Tomlinson___
<br />SOCIAL. SECURITY NUMBER U$Ur UAL OCCUPATION (Gi.. CIIdlf.wk N...4 -1,; M.1 [IND OF AUSINFSS OR INDUSTRY COUNTY Of DEATH
<br />125o8-12-9358 17. _ _ �-T. r _. 176 Qwa Rome 1.. -Hall
<br />CET(. TOWN OR LOCATION Of DEATH 11T'SIOE CI1 W OfNft INSTITUTION - Y HOY Ot MST L..wr DOA(Sp,X and Island b a Id1 7 and_ Island Meoorial Hos 14 Znyatimt _
<br />RfSIDLNCE - STAY/ COUNT► CITY. TOWN ORLOCATION —^ STREET AND NUMBER INSIDE CITY LIMITS
<br />fSP «.l, r•r o. Nol
<br />`I s. Nebras IK Han ,& Grand Island qua 40 W. 11th. St��Yes _ __
<br />!A N -NAME E i [ LAST i MdTMER - rMIDfN NI1ME fIRST wJDDIE LAST
<br />I Fyred KKI Bredeboeft _ ! 17._ Inez NMI Kohler
<br />WAS D[CfASfD [VfR IN U 3 AWED fORCESf i INf ORMAM -NAME- RELATION"IP - MAILING ADDRESS 410117 CH E r D NO Cm OR 1DM60IINL, FI[1
<br />II.. \I lH ,.. R•. .•. M dw« •. r•..N•) / UUC7 V.1
<br />Is No R/A �I +Waiter Tomjiq&on- _bustfuid =405 W. llth..Grad Island.,_.Ne.
<br />BURIAL, C..w...:en. R•—;I DATE ICEMETERT Of CREMATORY - NAME D:ATi " UTY OF 101N STATE
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<br />Jan. 11. 2_Q8��7�_OEReill Cem_ete �'Reill. Nebraska
<br />iN .Wel ......... N(fMF-HAMF AMADDRfSS ISTH[T OI R TD. NO. CITY (A TOWN. STATE. IM LOOM
<br />WHEN ,PHIS COPY ZARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT, OFDI�EALTH, IT CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />Or AN�ORItINAr�ti�C'ORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />BQR$ i3�OF VITAL; VTATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />V I�HJ►�. CORDS Y ;�,
<br />Jari. 21, 1985 `
<br />DIRECTOR/ BUREAU OF VITAL STATISTICS LINCOLN, NEBRASKA
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<br />.Liv_i�ston- Sondermann,505 W. Koenig, Grand Island, Ne.
<br />DATE SIGNED (M• D.Y. Yr) I HOUR Of DEATH
<br />DATE DEATX.{�.. , O.T. 7 ") _ _,.
<br />I
<br />23. ' 1 ( 4 (fJ i�E 74 o
<br />IGN ( D.,. T..) 'r)OUR DEATH I: =� PRONOUNCEDDEAD PRONOUNCED DEAD(N.ar)
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<br />IRATE
<br />!776. 1 177._ C._M `�A= �2A< —_Jidd
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<br />' 774 1$,.wr.n .M I.H.I �R . Lu-j 1. �_ 24. (SAP
<br />NAME AND ADDRESS OF CERTIFIER (PHYSICIAN. COfONftS PHYSICIAN CN COUNTY ATTORNEY) (lyp• a•rF—P)
<br />71
<br />7s r_G G. Sett j e 908 X., Hovard _ Gnmd._Izland,. Nebraska__-6B6Q1---
<br />RfGISTRAt ^ ID CIE ED BY REGISTRAR (M.. CI,y T. 1 �/
<br />7M (76 %�i .'�i /GC,�
<br />77. IMMEDIATE CAUSE ENTER ONLY ONE CAUSE PER LINE FOR (al. (b). AND (.l) / i ....wl �.w.... r.... ...d d.•w,
<br />PART t
<br />DUE TO. OR AS A CONSEQUENCE OF.i -r.±i H.M.. —.•. e.w dwH.
<br />DUE TO. OR AS A CONSEQUENC III E Of: — P W I b—
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<br />PART HER SIGw r[µ1 CONd%0 .1 -_Z `- •.ww.Y.ry r d•.r• S.; w r.1..•d iARI �u r slr,A:l w S iHI RI A AUI0`SY WAS CASE "Itwo SO rINCA,
<br />PR IGNANC, IN THE PAST, MONTHS? (Tp «J. Y« r WI 1 —.12 CA CDfONEf
<br />ACC,w_ SUKID[. H CIDE. UlwMIT DAII d r•uv.T L.M. 0.T Y.-- T�wOUf CY IrUUET I DISC.6f __ Iru UIY CICCUIfED
<br />ON 11.40.0 .m311G.T.DN n-41
<br />UP 130111 1 30L M Tod
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<br />Si.EET CM • i D W CITY OR IDWH STATE
<br />11i.w Wl •Il.r• 41d.. r (Sa.. A,1 Ia... ,n..
<br />WHEN ,PHIS COPY ZARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT, OFDI�EALTH, IT CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />Or AN�ORItINAr�ti�C'ORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />BQR$ i3�OF VITAL; VTATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />V I�HJ►�. CORDS Y ;�,
<br />Jari. 21, 1985 `
<br />DIRECTOR/ BUREAU OF VITAL STATISTICS LINCOLN, NEBRASKA
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