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<br />STATE Of NEBRASKA— DEPARTMENT Of HEALTH $s-. 000,918
<br />BUREAU DF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />MIDDbR IA
<br />A AN., . ..
<br />Dick Jacob Nietfeld Male December 28, 1984
<br />RACE -I..R. « i, Aw. ri.. w0 116LN/D[SC[N►(•.E „IMlia",M«k. ", AOE -I.p fiwy.r UND[IITEA! U tl Y DATE �TNrw..oq. Y..)
<br />rf[I�te P«Nrl O..-.• «I.)(S if►1 (1'N.)
<br />S. DAYS HWRS • MINS.
<br />American Q� 86 July 23, 1898
<br />I A PW 51.1 E Q, saIm ( .•I i. U.S.A., CINZlN OF WHAT COUNT MA N v MAR NAM[ CW SPOUN ( .R,r,, "e...•)
<br />WI ED, tDfSp�,i/,)
<br />Rranc� Island, Nebraska , U.S.A. ,arr e i �; '06lµ „Ella M. Wilhelmi
<br />uu SECURITY NuMtER UwAI OCGUPAt1oN (G;.• Li Ie.I.M hA• s «illy -.H EfN1) 01 Us M of INDUST" G a MATH
<br />13. 506 -09 -5347 1(30 1d•...•" n..ri.•el
<br />I3.. %teat Cutter ,y�afeway Grocery tA. Hall
<br />CITT. TOWN OR tOCAT10N O► DEATH INSIOf CITY 11IM15 MOSIIIAI Ot OTMER INSTITUTION -N-e, (If l.er i. •iM•,, MHOS►. Ot NISI. I.dll.!•lOA.
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<br />Grand Island, Nebraska "Q`es --
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<br />RlSIDENCE -STATE COUNIT CITY, TOWN OR LOCATION STtEET AND NUMREI THEM CITY tUAITs
<br />Is.Nebraska CO Hall I3,. Grand Island Ise. 105 W. Ashton
<br />U N -IMU N NAM
<br />1 Dietrich - Nietfeld ,1 Dora -- Ritter
<br />WAS OEC[ASED MR IN U.S. AIMED POtt!ST IN►ORMANT- NAME- REIAffONSNII- MAµ1NG App11ESS ISINII W WI.s. NO., v. p TOMK Sufl, ZNI
<br />Ri- e« •.I 4M. N . —.1
<br />IR. No I1Ella Nietfeld wife 105 W. Ashton Grand Island Ne.6880:
<br />[U[IAI.Cr•w6-.1T. -...I DA CIMETERY OR CtEMATORY- NAME LOCATION CITY on TOWN STATE
<br />Dec. 31, 1984
<br />x.. Burial xb as Grand Island Cemetery x.. Grand Island, Nebraska
<br />ATURE 1 EN NO. ' 9 f VNERAI NOME -NAME AND ADD /ESS IsINEI Ol 11s. No., cm q LpYM, sn1i, il►1
<br />21. 7 73. Apfel- Butler- Geddes 1123 W. 2nd Grand Island, Ne.68801
<br />f .. D•r. .1 DA N "Out of OILATPO
<br />":9 a... 1/2/85 aw. 3:40
<br />�2 A IM•., D.P. n.1 NOUR D A N:r' ►RONOUNC[DDEAD • M
<br />!} PM)*oUNCED DEAD (N••,)
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<br />a3b. 7h. M i= aA<. 1 /28/84 3:55 p.
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<br />23 jsfa�."fid.pw 21•0 13l,...w..w r:.N► a- c�. e f , i k� nl
<br />NAME AN A E E! 1 t (PHYSICIAN, COlONER'S 714 YSICIAN OR COUNTY ATTOENEr1 1_ e• I,iw11
<br />Steven J. Moeller, Deputy Hall Count�Attorne
<br />Grand Island NE 6880
<br />srRAR
<br />�/ �/ - p D 1I EIYF RY REGI TRA! (M•
<br />AY (EN►f! NIT ONE CAUSE PER LINE POE (ol, (b), AND (,)1
<br />rAfl Nr...l b.l..•.. --... e...
<br />;., congestive heart failure
<br />DUE TO,
<br />A 3lOU fEG
<br />� I.I...el b...... •.r W d.Nb
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<br />OW TO. OIL AS A CONSEQUENCE 01,
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<br />PART AN C IWNgNL -CIO .wn... w,bl., b I «w ►-.« •N.M IAIT 11 1! II51 WAf IHIII • AU C-v- M a CAN «lltl/D W - EDICAL
<br />! !•lO/YNC. IN TIN ►ALL 7 MDININf fE...I, 1« « w1 1:111111,11 OR COROMR
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<br />301.
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA 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 />VITAL RECORDS.
<br />Issued Jari. 7 1985
<br />DIRECTOR® BUREAU OF VITAL STATISTICS LINCOLN, NEBRASKA
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