|
WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA. STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE-- A.;TRUE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTxtl�r °vF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAt.DEPOSITOY' OR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE t
<br />MAY 14 W5 STANLEY, S. COOPER,;
<br />-- DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU` TIE• MAI...STATISTICS
<br />sTATC OF IIMASMA- o6►AATMEMT N MATH V�- 002454
<br />o1M" of VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />Frank Samuel
<br />toes -N 11 - W%"- N.tf. A«.,.t.eIOt10MV
<br />Eef.... *JtSpr.ye 6«ert
<br />A White
<br />CffF1QFSTA1FO6 e1Fe11(X e.r :e U S A-
<br />•... lffe«r)
<br />aHa12 County, Nebraska
<br />SOCW tM wwrHa Tyv,3y0ea
<br />1.2712-05-9260 1,�2a1:
<br />C tir, tOWN 6i SOCAnom OF "ATA� - --
<br />IM ,:grand Island
<br />nS"wce- Sean caFwrr -
<br />I
<br />Nt,iiP•rrEl, •- •ww•wwr. f -4•M
<br />erman �0 ,r•"
<br />i- 91
<br />Male j, May 6, 1985
<br />(Al. Der. T, I
<br />td 26, 1894_
<br />IWIDOW00, OfYOfCtD(Sp•r,IV) '..,...»v. an+vxln..t•.f »•«.iMesawl
<br />U.S.A. i,D Married �„ Ida Lipke
<br />ON (G:.e •"d el..ari /arti drn.p �w•p KIMO OF tUSINESS Ot SIIpUSTef I COUNTY OF (SEAINT
<br />i.(wo -0)
<br />car factory_ j
<br />NA „f U. P. Railroad Hall
<br />IN! CITr LIIIMNS NOSIITAE Ot 0114'a INSTITUTION -N... (to n j ...� Lir npsr q �NSf I.IHea 00.1
<br />(s.e.rET rH«Nsl ins ,I.••te«f wrr«f•r It- A.I,ne „r.yr «drr
<br />,k, Yes _ ,w VA Medical Center �,h Inpatient
<br />StfllT AND NUMf[f INSIDE CITY SMUTS
<br />is. Nebraska II% Hall !is Grand Island S,. «.(,T,.,N.I
<br />♦ - , isi3ebraska Veterans Home des
<br />f t,{ u �Yaw_euA(f sd. _ ztec./1tSj.GfI ) . eM/
<br />D a� 6 e-v-F� e t r2 e8i {N � d- U v _ e1 rN i. " �tc1ff0 k (D -..- Otto
<br />9R t - _�t_o
<br />- _-"-S�' - jIpU- N..NF_ r_OEi_ftM.n1.._1 A gsOT _ yM..-t u
<br />tNh A-M-•F . . O - (.-do--eD-. R-a.ES..S _ - _ - T--
<br />fhf eSrS : f es- a-'
<br />U
<br />He
<br />s3—sree. _-
<br />r
<br />. NAM- - f /A rIpNSNIr M ep T if fOM
<br />9 _ S11
<br />0 -1 an— E688. —r.
<br />pe I
<br />_ n1 _4 r ansl
<br />CtMerer W CJtM4101r _ NAME LOCATION 0” w TOWN
<br />7. Burial 9, 19R5 m Grand Island City Cemetery DGrand Island, Nebraska
<br />- __4 1
<br />1 D it0 C n q TOn'N S tl EIr�- - _ �� � - --
<br />'2,LivinCston- 3ondermann,505 1W. Koenig '?t Grand ?slrad, Ne.
<br />-
<br />� i
<br />1i23.�•. it. ltMay
<br />3itf�f w 6- i ..�N1985 �N• � dV•. •�M " « ..h - .-v h - . ;N or. vtr`. h� , r «rs W • t a a - � 1 i 'Ys; E 06tmi 1 =
<br />Y .f(08OW?].�• . ° •. . ., - nb' II e I, N N 1 1 0 .l
<br />- M_"S. »� r i r, W. . / • _ . ,.f.r-rmoyd N7a W.MOs «_
<br />r.nDa, f - - MA- _ O..e- _ (r • N May 6r 1985 d a 1
<br />N - J N -ft
<br />-__'—
<br />a_
<br />M •+• teY M d d•.• ! H +tnY 141N
<br />i r f wf,wa,e H I.,1« _ _ ^ � � . -.. .1 i.• 1 f Y .v/ I H
<br />(jRONIRS h1i1KIAN Ot COUNTY At1peNFT.
<br />F.nri oats A fsellosil2o,M U„ VA Medical Ce.n. ter,2201 N. HroaLjwell,(,rand Island,NR68801
<br />/ - i 0w1E fectEVlt h eec3s +TUie rM o ®;.. , __.
<br />flea ► Awe i�i �/ I •f
<br />1011.
<br />_ tAVii' iwtfM'o+wr vtt
<br />�«
<br />Congestive ee,rt failure f days
<br />.,d ewin_. .
<br />Arteriosclerotic heart disease
<br />__._ d3tsirbf/stouiiteei .. .. -.- _ yrs
<br />Hw
<br />.^d'e. ° „MH....M•(/ .s dwM wy nee .kepO ft IN H •w.l,�F - � 1NIf1 • �AUtlN31
<br />Pneumonia -
<br />« l ` a to W •N ®NANCr IN vN! rAt/ 7 MONtN3r Sr« ( ,« v N. `iMaNli w d f NDKAI ... -_
<br />of P".9 , A 6V1d :- i10t�1t1� DwiNi � '0411 at iiiiuit IM. D «.._•
<br />, ndNet a rwuF -... _ 'MSC MI rtpl• x•i.sft O+CUfpD ... '” .
<br />....._. --
<br />4 �
<br />M )Od
<br />.'._... -_ .G•NRI�At»Mt-- Aif•arr levee
<br />111.7 o—'. I «irrT. -.. . �IOYAI�1•
<br />i ffd«/, TYSIM s"S4 enH•f«Aq.f. •h
<br />� IT q tOwN
<br />T
<br />5�
<br />7
<br />{
<br />vE`'
<br />
|