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<br />1i7 <br /> <br />STATE OF NEBRASKA- DEPAR1MENTOF REALm AND HUMAN SERVICES F1NANCE AND SUPPORT <br /> <br />200 807 869 CERTI~~A~r;;~EATH <br /> <br />I DECEDENT. NAME <br /> <br />FIRST <br /> <br />MIDDLE <br /> <br />LAST <br /> <br />2 SE~ <br /> <br />3 DATE OF DEATH <br /> <br /> <br />Betty <br /> <br />Annette <br /> <br />Trueman <br /> <br />Female <br /> <br />March 14. 2000 <br />&, DATE OF BIRTH r_. (My y_ <br /> <br />Grand ISland <br />7 SOCIAL SECURTIY NUMeER <br /> <br />Nebraska <br /> <br />5,0. AGE - L"'_Y <br />IV,.. I <br />45 <br /> <br />UNDER I VEAR <br />51> MOS DAVS <br /> <br />UNDER 1 DAV <br />I<: HOuRS MINS <br /> <br /> November 22. 1954 <br />OTHER 0 N.....ng_ <br /> 0 -....,. <br /> 0 0ItIet' I SlJ<<I~1 <br /> <br />.. CITYANDSTATEOF6lRTH ,'notinUSA,,__1 <br /> <br />. <br /> <br />505-86-3929 <br /> <br />Go PLACE OF DEATH <br />HOSPITAL <br /> <br />~ <br />D <br />o <br /> <br />ER 0uIp0bM1I <br /> <br />,- <br /> <br /> <br />lib. FACilITY....",. <br /> <br />1'''''_,gI''___1 <br /> <br />UnIv. of Nebraska MedIcal Center <br /> <br />OOA <br /> <br /> <br /> <br />911. RESIDENCE" STATE <br /> <br />!Ie. INSIDE CITY LIMITS <br /> <br />60. CITY TOWN OR LOCATION OF DEATH <br /> <br />Omaha <br /> <br />Nebraska <br /> <br />v.. [!J No 0 <br /> <br />13 NAMEOFSPOuSE 1'_.___1 <br /> <br />OIC-IISooe~IWhi te <br /> <br />l~ish/swedIsh <br /> <br />LAST <br /> <br />17 MOTHER <br /> <br />18DDLE <br /> <br />_e~1 <br />CoIo9t 11-' '" 5-' <br />2 <br />MAlDEN SURNAME <br /> <br />'... USUALOCCUPATlON Io-_af____- <br />af_<Il9",_d_ <br />PreschoOl Teacher <br /> <br />, <b KIND OF BUSI'lESS INDUSTRV <br /> <br />PreschOOl Education <br /> <br />~T <br /> <br />18OO1.E <br /> <br /> <br />Jeanne James <br /> <br />MAILING ADDRESS <br /> <br />Arden Leon Trueman (Husband) <br />ISTREET OR Fl.F 0 NO.. CITY OR TOWN_ STATE, ZlPI <br /> <br />159 East Airport Road <br />20. EMllAUlER. SIGNATURE & LICENSE NO <br /> <br />Grand Island, Nebraska 68803 <br />21.. METHOD OF DISPOSITION 21 b_ DATE <br /> <br />not embalmed <br /> <br />o Bu<,al D-a1 <br /> <br /> <br />21e. CEMETERV OR CREMATORV - NAME <br /> <br />22., FUNEfW. HOME . NAME <br /> <br />CITY OR TOWOl <br /> <br />John A. Gentleman Wests ide Cha ~ c_ 0- <br /> <br />Oli1aha, Nebraska <br /> <br />2211. FUNEfW. HOME ADDRESS <br /> <br />ISTREET OR RF 0 NO. C[TV OR TOWN_ STATE. ZIP) <br /> <br />23. IMIolEDlA TE CAuSE <br />P~RT C ", V <br /> <br />1010 North 72 Street omaha, Nebraska 68114 <br />IENTER ONL v ONE CAUSE PER LINE FOR ,.,. Ibl, AND lell <br />PV/i' V,.,O~/ /I <br /> <br />1" <br />DUE TO, OR AS A CONSEOUENQ: OF <br /> <br />""" '0 &- r~ trl c.. <br />II I( IT (. 0 t;... t;" ~ V ~ <br /> <br />Il1I8t'IiaJ b8t'wMn on&et ana M~ <br /> <br />7 0 <br /> <br /> <br />Ibl <br />DUE TO_ OR AS A CONSEQUENCE OF' <br /> <br />/t-CvrC <br /> <br />Co~tl <br /> <br />~U>OO <br /> <br />fil.H&P(.^~r <br />L. t:-~ 1/7"(( 4 <br /> <br />Interv~l befwMn ()nHI ana l;tealf'l <br /> <br />3 110 <br /> <br />lnIItrval b4!MW8en onseI ancl 08.'" <br />2 4es <br /> <br />101 <br />PART OTHER SIGNIFICANT CONDITIONS - Con<l/II<lOO ~ 10... ""am.... ""'.- <br /> <br />· 11 V' M - () p. (,. ~ - $,1.( s n;M P'Att "",.. <br /> <br />260 <br /> <br />ll5l>. DATE OF I~URV IUD. {My. Y'J 26<. HOuR QF '~URV <br /> <br /> <br />269_ LOCATION <br /> <br />STREET OR A.F.D. NO. <br /> <br />CITV OR TOWN <br /> <br />STATE <br /> <br />o IlCc__ 0 ~ <br />o Suo;;"'" 0 Pon<long 2lIo. I~URY AT WOflI( <br />o -"'" ~ v..D NoD <br /> <br /> <br />27.. OA TE 01' DEATH I""'.. uo,- Y'-J <br /> <br />3/'t I 00 <br />27b 0'1 i;; ''''''/OOJ <br /> <br />260 DATE SIGNED IUD.o.y Yn <br /> <br />280 TIME OF DEATH <br /> <br />?~ <br /> <br />sU <br />!~~ <br />i;> <br />~d <br />in <br /> <br />M <br /> <br />Vo TIME OF DEATH <br />(I. sr <br /> <br />26e PRONOUNCED DEAD IUD.. (My, Yn <br /> <br />:1ll<l. PRONOUNCED DEAD IHourI <br /> <br />M <br /> <br />M <br /> <br />28e. On d"It) b8$I$ 01 $IamtnatIot\ ancJ CIf ~. 11'1 my ~NOrI 01. OCC~. <br />It10 .mo, ""'" and .. and ..... 10'" COIMf" __ <br /> <br />JO.b WAS CONSENT GRANTiD" <br />o VES <br /> <br />~NO <br /> <br />I'f (;yQ c f1.. <br /> <br />Y""" <br />-J) <br />',U.. r- _It' ;: . <br />. ~.. . " <br />,L' "... ""f - .' <br />This cer~(f1e~ thi"L.-docUlJC..ilt ~t'~ '. true copy of an <br />Statisti~:i~~lat Countt ~e-a~DepartJIent. CDaha, <br />a raised s.a'1.,A~.tb$I area. .to ~...l.ft. Reproductions <br />, It ~ ..... ~" <br />legal copi..., ,I JOO ~'"t(". .,."" , <br />~ U \ -, <br />Date issued":' ~.'t4ARt 52000 Re9hturl <br /> <br />original record on file with Vital <br />Nebraska. Certified copies must have <br />of this green certificate are not <br /> <br />~i'0~ <br />