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<br />WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES <br />SYSTEM, IT CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECORD-ON. FILE WITH <br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA TISTj~c$t;ClJ~~CH IS <br /> <br /> <br />:u:~;s~;:io:YFOR2V10T:::: 4 6 ~i~~ <br /> <br />LINCOLN, NEBRASKA · HEAL TH AND.J;It!MAii.,lER'fiIc~$"'s'iS;i~ <br />. .'~.< _.~~ <br /> <br />STA1BOJINllllASKA-IlIPMDIINTOfIllAL'lHANDIlUMAN llIlAVICII&~~ ,,_..,- <br />CERnW~~'o;DEATH ,,{_~__H_~"-~,'or- 06344 <br /> <br />I. - _ flIIS1 -.; LAST 2. SEX a. DlAlM ....... DtI1I. ~ <br /> <br />... CITY <br /> <br />Raymond <br />ATEOFllIRl>I lIIot<</IoU.S...._-w <br /> <br />Carl <br /> <br />Schmidt <br /> <br /> <br />Male <br />-. y <br />50. HOUIII ' lItIS <br /> <br /> <br />at 22, <br /> <br />iJ........- <br />0-- <br />o ~..... <br /> <br />1912 <br /> <br /> <br />5& -U.llIoIhIIIlI <br />IV'" 88 <br /> <br />.. PLIlCICIl'lEAlM <br />~AL;O...... 0I'HEIt <br />OEllOolllllllol <br />000. <br /> <br />011 LOCATION 0fI DfATIof <br /> <br />Grand Island <br />. STAT!! ... COUNTY <br /> <br />..- <br /> <br />Nebraska <br />II. 1IACl. ~ -'1IIclI. __. <br />....ll8oocllrl <br /> <br />White <br />,& USI/AI.llCCUI'A_ --"'-_'*""'w_ <br />d"",,'-_I_ <br />Farmer <br />'I. FATIlifl. NAME <br /> <br />CGIiIllt "...... <br /> <br />IWlT <br /> <br />IMIDLE <br /> <br />Martha <br /> <br />-~ <br />L1s1us <br /> <br />2tD. llo\TE <br /> <br />I1c CIIIlElDh' 011 CAEllAT ... <br /> <br />KJ- 0- <br />Do.-.Deo- <br /> <br />Prosser NE <br /> <br />411 West 11th St. <br />ID _TE <br />IWIf <br />'... CVA <br /> <br />P.o. Box 126 WOod River NE <br />010II. y OlE CAUSE PEA 11'.lII!. NIlJ lCll <br /> <br />68883 <br /> <br />----- <br /> <br />o <br /> <br />TO. 011 AS A <br /> <br />----- <br /> <br />IIlI ATIIDOSCLEROSIS <br />CUE TO. 011 AS A OF' <br /> <br />l!ll& <br />0-0- <br />o Suo:oIlt 0 _.~ <br />0- ~ <br /> <br />llIII> DATEOfIINJURY /1111.. o.r Yr.} tee HOUIIOf_ <br /> <br /> <br />40 US <br /> <br />----- <br /> <br />tel <br />""'" <br />. <br /> <br />Il'lII <br /> <br />COIiOlTlOIIIS. c-.............,..... _llulOOl_ <br /> <br />BPH <br /> <br />a. lNJUAV AT'MlIIlI <br />,.0 NIlD <br /> <br />2Ig. UlCATlON <br /> <br />STIII!ET 011 IIF.D. NO. <br /> <br />CITY 011 TOWN <br /> <br />stATI': <br /> <br />trl. CIA <br /> <br />.......,..YrJ <br /> <br />2lIa DATI':_D (IIo.../Jay Yr, <br /> <br />_ TIllE Of OEATIt <br /> <br /> <br />8' HAY 25.2001 <br />I ... "" DATI': I10tlED /IIItI.. /Jay Yr/ <br />lit! IlAY 30. 2001 <br />{! Z7d. TGIIIa_"",,"-""lflI. <br />_11- <br /> <br />__DUD _ <br /> <br />II <br /> <br />1'.- <br /> <br />3ll.ItWAS~_ <br />OlES iJNO <br /> <br />32a <br />