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<br />86- 106437
<br />WHEN THIS COPY CARRIES THE RAISED SEAT, OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO.,BT A 7s'Rt1E';GOP1
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DE,PA�'1'�NT
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEG¢!: =1TOSITOAYFOR
<br />VITAL RECORDS._
<br />DATE OF ISSUANCE v�
<br />OCT 2 7 06 STANt:E�f� � CpOP$lt, ��iISCTOR
<br />LINCOLN, NEBRASKA BUREAU 01tziTAL;$ATISTICS
<br />STATE Of UN A M- WRIARTMEMT OF NMIN
<br />Ot10EAY'W WTAt STA'"SMMtS
<br />CERTIFICATE OF DEATH �r r
<br />_
<br />f DA A "(M.- 1. r•.) —
<br />Charles Mayne McCleery
<br />Male October 14, 1986
<br />--
<br />- I.,R., R(..ti AwMllw SCRNTN -7.. 11.II.w, alw: —. AOE -1w. 9-Ndr NDER ITEAM kf!- IOAT WTE O. MOM fm.., D.►•rT l
<br />Jt5l.Ii/,l M1.1 1, .105. DAYS Nom: AWNS.
<br />otc 6S !�k 13, 1921
<br />A. ite rish 0 ,February
<br />MAW • ..r i. Y, A. 1 Wt1A cOU NAA1E SlOIISEf, Ri.. �A.iil.
<br />OfVDRC lilasrrrl
<br />iFa`si4�gs, Nebraska , U.S.A. ,e°Oi�°airie�D „Pauline Beare
<br />to NIWRRf UN/AL OccurAIIpifCd.. ►..oaf.., ►MA.4.i.0aw / ,RRID OE OUWAU OR WMUSTRT COUNTY OF NAT
<br />CLIA SOME"
<br />-10 -6924 tmcf-Wlver 113b Farm Implement ,M Hall
<br />„S06
<br />COT. TOWN OR tOCATRSN Or OSAIN Mum C1TT►IAwtS 11OSMA► OR Of”" MSMUTION -NOar ("-- a:Ma,. »"*W 041 WST 00►.
<br />ri,« NF Na/ M "O WAical Center ,w Inpatient
<br />Grand Island i
<br />146, ,4
<br />MISIN"cl -STATE COYMT C1N. TOWN OR LOCATION STREIT AND NUMM MNDE[m IIWTS
<br />CO
<br />South Vine
<br />M. Nebraska Hall ,,, Grand Island ,,, 1103
<br />FATHR-04AAW POST 1J1 MOT"" -Aw wNA it ", AWOME
<br />(dec.) Mayne McCleery �1 (dec) Edith Noble
<br />-7
<br />M.
<br />WAS OKRAW MR IN U S. ARMRO lORCEST f IN/QRMAM - NAME -- RftAr0WW» - aw:lwe AooKSS Is*NN a :. O W . Pt• p Tp.w. S1.ee »,
<br />;,Qauline 14cC.leery,wife,1103 S. Vine,Grand Island,NE68801
<br />WRIAL C,..w�.w. c mfx T M cREA1ATOW -.. "*AM l6c•lwx4 cm oR TOWN SIASE
<br />Oct. 17, 1986 Nebraska
<br />Burial n►, �., Ft. McPherson Nation_al__ Tw
<br />_Maxwell,
<br />UNERY NOME - NAA1E AlID ADOHSS _ pTMtl p f 1 O .lD t.TT Oa 10". NAN. il«
<br />i,Apfel- Butler -Geddes 1123 W. 2nd, Grand Island, N£.6880:
<br />GM Of WAVII w.. . -1 '_- -- —' M. Dr r, f i "M DEA
<br />October 14, 1986
<br />tA1.. r.T.l -�� -- —�� lwwouNceooe+.D — ?- ►RONOUwcEODEAO(N..,,
<br />'
<br />�
<br />�� 7 -SO p,
<br />October 1S, 1986
<br />i5► Tit
<br />S
<br />It 0 w». A...r «........ wti. w.r. .r«-w .... �.....A ..
<br />..w.ww.i..1...rya w.•�..ws .. r »ar. aaa, w.W. iy'—_
<br />� y +. •...Mw.W.wMrra...lr.wr
<br />W raw
<br />:rTy.wu
<br />f f'NT IAN 00 COUNTT A T) I 104 -
<br />Leticia
<br />M. Pinto, M.D., VA Medical Center,2201 N Broadwell,Grand Island,NE 68803
<br />OCT 2 0 196
<br />agiflJOW C^US# !ER 1INE FOR 1.). t►). AND /a)) IwunN fM.»r v w a.aA
<br />Acute respiratory failure _ _ _ 2 days
<br />Olt AS SW • • E
<br />Respiratory infection 3 -4 days
<br />_
<br />Severe chronic obstructive pulmonary disease Yrs.
<br />I*" UNION � ea1M NYML w 'aYt Y aN1AN0 q WOKM
<br />w T11e '"t f np11W! «p
<br />No
<br />Cor pulsonale . «:: N.:. :. - - -- -�T __ __ _
<br />. RNCOL 1atw 1111RTT . "It Or, .Mor, fYa fN,. T. , MOYa O. xWUn Rt1(: N1 .qr 1WYaT OCC Va«O
<br />a twrr./.wRAT.s1a fT!«.rrl
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<br />INC - - - -- - - -- - -- -
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