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<br />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 DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS.
<br />,� DATE OF ISSUANCE
<br />FEB u 0 Va8J STANLEY S. COOPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
<br />85-- 005376'
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH tj
<br />--------- - - - - -- --
<br />DEN -NAME FIRST MIDDLE LAST SER DAZE Of DEATH
<br />I Clarence Brown Mumma i, Male 1, February 7, 1985
<br />RACE - (e.R., WIiN. R1.1f, A1w.rk.n ORIGIN 015CENT I. E•, Il.li.n, M.xk.n, AGE -W., V.W.. UNDER i YEAR' UNDER 1 DAY DATE OF RIR1H (M. , Un I. yr
<br />IwdrWiNeexrlY) s. UnSpeeilPl (Yn.) MOB. DAYS HOURS. MINS. b
<br />1. FfEffll nk wn- b.. 84 bb. x iz Feb 3.
<br />CITY A ATE OF BIRTH (II Ti iw U.S.A.. CITIZEN OF WHAT COON RY MARRIED, NEVER MARRIED, I NAME OF SPOUSE (If r;le, g;.. n dew
<br />e.eH wewxvl �l WIDOWED. DIVORCED (SpeCd11
<br />R. s. ID. ie �n Ida _1qe Robv_____
<br />SOCIAL SECURITY NUMB USUAL OCCUPATION(G;,e find.Iwn1 done d.I;.R wren RIND OF BUSINESS OR INDUSTRY- TCOUNIr OF DEATH
<br />el.erfiw lih, new it nr;ndl
<br />12 . 712 05 2897 13. CEonductor ub. Railroad .1A. Hal_ i
<br />CITY, TOWN OE LOCATION OF DEATH INSIDE CITY LIMITS HOSPITAL OR OTHER INSTITUTION -N.- 11(not •n .,rh.r, i 11 HOS. OR 1.51 Iwa;lnr. DOA
<br />(Spexil Yn er N.1 ob. Ilr..r and n.Hbo) ' 0-.1'11 A- (5r 1,.
<br />,.`. Grand Island ,dP. Iles , /d. VA Medical Center ,.Inpatient__
<br />RESIDENCE - STATE COUNTY CITY, TOWN OR LOCATION STREET AND NUMBER I INSIDE CITY IIA11T$
<br />,.. ebraska ,56 sa.n/ Y.... N.,
<br />N Hall 115 Cranri TcTanrl 1,5 252.0 W- .Tnhn �
<br />A H -NAM U T MIDDLE
<br />LAST
<br />MOTHER - MAIDEN NAME FIRST e510D1E
<br />rb. (dec. ) Daniel Barnet
<br />Mumma
<br />17 (dec ,) Marian F
<br />WAS DECEASED EVER IN U.S. ARMED FOREST
<br />__ -Brown
<br />INFORMANT -NAME - RF/ATIONSHIP- MAILING ADDRESS 151.EIl OI ( I D NO. CT OR TUwN. 5 1AI(, :111
<br />`
<br />• «..6) 111 I.,..;w Mr .wd O.N. .1 ,en•..1
<br />IR. Yes �8 -11- 19/6 -8-21
<br />19Ida Mae Mumma ,_Wife, 2520 W. John, Grand Island. NE -6E
<br />CEMETERY OR CREMATORY -NAME 'LOCATION CITY OR TOWN $TA1E
<br />RURAL. CI.H.Ii.w, I.—IIIIATI
<br />?D.. j(b. eb 8
<br />roW t wn Memorial Park ..Grand Island, Nebraska
<br />IMIR UCn LICENSE NO,
<br />FUNERAL HOME -NAME AND ADDRESS (S1IEl1 OR 1 o NO. Crrr OR TOWN. STAIR. 21r1 688o1
<br />Z /
<br />21 7
<br />),?Livingston- Sondermann,505 W. Koenig,Grand Island,_Ne.
<br />DATE OF DEATH (M.., D.P. Yr.)
<br />DATE SIGNED (M.. DoT, Yr.) !HOUR Of DEATH
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<br />jj.Fe�b�ruar,�Z
<br />A 1 ND i
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<br />- �o
<br />- - --
<br />1.) HOUR F O DEATH
<br />Ij3». February 8� 1985 2 10-30
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<br />►fONOUNCED DEAD rgONOUNCED D[ADin..,r
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<br />Leticia M. Pinto M.D. VA Medical Center, 2201 N. Broadwell, Grand Island, NE 68801
<br />RE ISTRM �-� ' �6A_T!RE IV D EY REGISFRAI (M... D.1. r1.!
<br />7M.rf, ..H..)�
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