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STATE OF NEBRASKA -DEPARTMENT OF HEALTH
<br />6UREAU OF VITAL STATISTICS oo 76 { IyNJ p
<br />CERTIFICATE OF DEATH SO 85- 1
<br />EDEN -NAME Ft MIDOI — LAST SEiI GATE OF DEAN (MO., Dpr, Y,.1 —
<br />`x He en Dieken _ Duly 4,1984
<br />lAtf- I..B.• WSdt., Rbtk Arty,iTen ORIGINIOESCENT(.q,ITeIT.n, M..k.n. AGE -t.M .;r.bd.y UNDER 1R I tEAR� UNDE! 1 OAT DATE OF BIRTH Ab., Der. r..)
<br />M.Idi.w, NtJ(SPetfil Gw.lo., M1.1 (Sp.rH,l Irn.l LAOS. DAYS - -�— NO{flS; MiNS. r
<br />.. to tlermar7 �. 06. ' ,, July 5.1895
<br />I
<br />?AT q BtlTN (b mT in U.S.A, CITIZEN OF WNATCDUNTRT MARRIED, NEVERMARRIED, a
<br />w..n cwwrr,l NAME OF SPOUSE (U.i(.. Rir. uee:d.n n.w.l
<br />WIDOWED. DIVORCED(Sp «ify)
<br />• s. U.S.A. to. Married ,,.Esther R unecke
<br />SOCW SLCU1m UNNER USUAL OCCUFATIQN (Gin F efr.A dew. d.N.R .wtT RIND OF RU51HESS OR INDUSTRY F
<br />C
<br />606-44 -2020 OUNTY Of DEATH la iCUltUre CITY. TOWN OR lOCAa DlATN Aiss
<br />OMITS NOSNTAL OR OTNEf INSflTUTION - NeM1. 111 noI in eilM•, D N031. OR NIST 1•d:cm. DOA.
<br />fa0t 8 (SP.,' Yn w Ne) pin t and w�l�erl, O•Iwr +nf /E.w. o .. x.wr.,.lsrra"
<br />' 14. +e8 I.d. '^"J +�++tZiilg 1'IC1S Ztal I /a. Boer. Rm.
<br />REStMNCF -STAY! COUNTY CITY, TOWN OR LOCATION STREFTANDNUMSER
<br />li Nebra� SE_ INSIDE CITY N.)
<br />�wV 1ss.13�►i1 ISt. PMeser ISd, ltt.l rsp.Tlt�r.twNa
<br />Aum LAS MOTHER - MAIDEN NAME FIRS MIDDLE 15. LAST- -
<br />IL Here 84rw Dieken Fulke
<br />WAS DECEASED EVER IN U.S. AWED FORCES? INfOWANT- wil't`s Peters
<br />IT— _ .<,,.N ,n � N Q*kl@LA IONSHI►- MAXING ADORE55
<br />A4..w Nr ewA ben el w.o<el ISltttT W R I D NO. CITY 0110WX. STATE. Zlry
<br />Is. 1gEsther n ek�n A;e, lit.l Prosser NE. 68868
<br />BURIAL,CnNSrien, Rmw 1 CEMETERYOR CREMATORY -NAME
<br />IOCAT1pH CITY OR TOWN STATE
<br />,a,Burial 20b.'luly 7,1984 7a. Concordia CemetelX god Juniata. NE.
<br />EMBALMER- SIGNATURf S UCZVSf NO. FUNERAL NOME -NAME AND ADDRESS
<br />ISTQET 01.1 O NO, C'n O• TOWN. SIAIE. ZIt'1
<br />21 %
<br />TE d ��°L127Jackson- Wilson Funeral Hie Keneaax NE. 6W968
<br />(AI., D.Y. Y..)
<br /><feaeNa.. k J l u 4 1R984 . ./ E-aAxiV t, '
<br />_ DATE
<br />, IaGvNr ED
<br />r Me. O.y, Yr.) IO� R O
<br />F MAIN
<br />M., 0., EAT '»j2A'. I24b j o PRONOUNCED DEAD
<br />M
<br />Jul Nxu (Me.De,. Yr.) P RNNCED DEAD(Nw)
<br />2 2
<br />i br.1
<br />M M.
<br />N • ned a
<br />GLL'T<LL (LW 4r G2- i1ft� r<. e
<br />. /SAuum awl TiM.L'" 2... ($�pn .nd
<br />ANO A - ITT -1f! (I YSICIAN. CORONE!'S T51C OR COUNTY ATTORNEY) f (yp. -
<br />Kevin K. Wycoff. M.D.-P.C., Ph sicians Bldg, Hastin s 11 br 68901 rum RftilKev
<br />d I�n OAT. RECEIVED SY REGISTEAR rM... Op,, Y•J
<br />ZS..( /� i7
<br />L
<br />,nM.nd dwd
<br />OUE ��A�C��iSE }OUnE�ha'.In-.
<br />M HIV `V AL (�(�/�RU-&'- tVAJ d)A-.1,G1R 1 IwbrwlbM..n w<N end dnrh
<br />DIIE T0, OR AS A CONSEQUENCE a: f/---
<br />Ine.n.l b.M1e.w -eat anJ dM<b
<br />kl
<br />PART CONDt/IONS- Cr.d<ns- r- w.b.nn, 4 dwd We nas <N.M tA11 IM O IIMAIl. WAfl",
<br />A AUTOPSY ,
<br />R ,,NTH,, ASX3T b WAS CAft QIER1[D TO MFpUI
<br />(Sn.rr fr .< Ne/ DIMYNH O. [010NR.
<br />. (y, Osy Y. 1 Ne
<br />«r/y
<br />v.. NO
<br />NOi Due OF INU1, Yet U ENCJ f 2—
<br />4ItKDe6 DPIESDG.TTON (SP-4) ACCIOEM. SKDL N
<br />301N. ]Ot. M 70d
<br />Z.." AT ORK a SOF whit! -M ►r.. I— ,Mrwl. to <r.ry. UXAINNI
<br />I1.rIRw,, Mt. fSPriry) STQFT d 11.0 N.. CITY q TOWN SlAlt
<br />701.
<br />RECORDERS MEMO —
<br />a
<br />WHEN THIS COPY; PARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEP T 0 ASALTH,, IT CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />OF AN 0MG1l4AL Rt ORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />BUREAU'OF41TAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS. ' ;
<br />Awn Issued July 24, 1984
<br />DIRECTOR, BUREAU OF VITAL STATISTICS LINCOLN, NEBRASKA
<br />IN
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