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<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH
<br />85_ 000381 BUREAU OF VITAL STATISTICS 83 05882
<br />CERTIFICATE OF DEATH . a qs
<br />MAW 1113T DL
<br />Ix OAZ OfW�TA H (M.., D.F. 11.
<br />Hazel Cleans Austin
<br />ifemale May 17. 1983
<br />-p.., W iN, , A..,kM
<br />QRgIN/OlSCFNiI•..., Eto ion, AN•aaw. AG! -b. NwAM•
<br />UNDER 1 YEA? UNDER , pAY
<br />DATI Of RIRIH(AM.. D.F. F.I
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<br />G«w/p g15J18�hJ r,' ITn.I ®O
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<br />MOS OAtf MOORS MINS
<br />J .1903-
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<br />N3+�i.TITSOF BIRTH (IF .0 1►U.S.A.,
<br />ITIIINOf WHAT COUNUYMAt IE .NEVER MARRIED,
<br />NAM! OfSFOUSI (if .i.,pr.w.N.. -1
<br />`Wand. IOYa
<br />USA oI DOW a ITOvaI P--IF)
<br />N[11NaD
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<br />'I
<br />SOCIAL SECURITY HUMOR@
<br />YEyAS OCCUPATION (G... Liw,1 .0 A •.w. 1- ...•./
<br />0Y1T@W4fINISS OR END STlt
<br />COUNTY Of DEATH
<br />11509 -32 -8602
<br />3. iie' "Crfiae Worker ?- jr
<br />,,, Automobil �l
<br />,M Refill
<br />I CITY, TOWN M LOCATION OF DIATN
<br />INSIDICITYIU +RS
<br />HOSPITAL Ot OTNEx INSIIVU1ION -(N wsru•dA•n OurwMMv .• MpIE 1 rIAN. L t R i.. M.....M. DaOlAl .
<br />{N.II
<br />,. Grand Island
<br />' N.)
<br />•� �
<br />5 y.rianear Blvd. ,N _
<br />R /SIOENCI -STATE
<br />COUNTY
<br />CI1►, TOWN OI LOCATION
<br />fTt!lT AND NyMRft
<br />INSIOl CITY lIM/TS
<br />N•,
<br />,stlebra&a
<br />T Hall
<br />,,,Grand Island
<br />,f .2513 rioneer Blvd.
<br />;�;"'�ee�
<br />M, NtMIEN NM FIN ST AU
<br />TEva
<br />jaw Edia
<br />_ ,6
<br />Thoas
<br />W IVII IN Y.S. ARMED FORCES/
<br />INFORMANT- NAME - RfLAHONSHIP- MARING ADDRESS (SLMEL OR R / D NO. Cm DE 2TL INI
<br />up fit 1- 0'- wd�.01 —.1
<br />„ 1'1erlyn E. i►ustin- Son - Spring Road, Grand Island, Ne./
<br />RYRIAL Cr\ he., ft . f DA
<br />CIMETlRY OR CREMATORY - NAME ' MANION CITY ON TOWN STATE
<br />MR, �±t� 20, 1983
<br />Ip,. Grand Island (City) tos Grand Island _ Ne.
<br />SIGMA UI S L E
<br />fUNfRAL WWI -NAME AND ADDRESS ISIR/fT OR R 1 D NO. C111 OR TOWN. STAB. 31H
<br />/ 7S'
<br />Livingston- Sondermann's,5U5 W. Koenig, Grand Island,Ne
<br />Eli
<br />T,
<br />PAT@ OR DEATH JAW. aE -i,.� DATE
<br />1.
<br />SIGNED (M.. .E. ►r J iNOUN
<br />OF DEATH
<br />a.. Tel
<br />83
<br />r.R 9:00 A. r
<br />DATE SIGN SIGMQ IAM., q, Vf.J INOUN Of DEATH
<br />=i. ►RONOUNClO
<br />r'Ci IM...
<br />PRONOUNCIDDIAD(N..,)
<br />DEAD
<br />O.F
<br />I3 ISr. M
<br />ix r
<br />5'%'17/83
<br />3:25 P
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<br />N w •NM n-4. I•A N M '
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<br />r �SH•'•N�•.N Tip)
<br />� • A ..,,rt.fl.0 f .,l.uAT.MYCKIAN n ■fnl1NTY AlTA.Nf11,f.e.
<br />I..
<br />13.8-.M /.\•1b L
<br />-Ir.N1
<br />Stephen Vannis
<br />P. 0. Boa 367, Grand island, Pte. 68801
<br />7T WMED1AIR CAUSE 799 ONLY ONE CAUSE PE! NINE FOR (s1. IS). AND (1), � —� Nw.•l .w.+a a.w .N N.A
<br />P Carrliac arrest unknown
<br />A CoNslafiffmcs be, ..+,..a...wa.a.1 .»....r
<br />au m
<br />O, 64 13 A CONSIQYINCE ON. I•uw.l b -...1, •.\.•.A
<br />�J 1
<br />,r1 _
<br />V; %ct 1< ONO' CI) -
<br />L I/y S / :'I it,n►�� ?1 T� f,r /1 /1{.,,(� Fs �l �, .••� 5J o5 .®a
<br />WHEN THIS COPY CARRIES THi RAISED SEAL OF THE NEBZASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE ABOVE 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 DEPOSITORY FOR
<br />V I T O R05� -�
<br />�7 Issued December 29,' 1993
<br />A3S I STANT-VIXECTOK-01; EA INCOLN, NEBRASKA
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