|
STATE OF NEBRASKA-DEPARTMENT Of HEALTH
<br />BUREAU OF YttAl STATtSTiC1
<br />CERTIFICATE DF DEATH~r,_ ~,p~_ 83'._.. () (1 ~'~~
<br />~D~F ~D~~T-NAM1------FIRST MIDOIE LAST 'SEX IDATE Of DEATH (MO, DaY•Y..)
<br />I E Xatherine Bahr zFemale 17~January 26, 1983
<br />R.AL` -tr.g.. Mq+iN, 85o.k, Amsriren ORK.tN(OfSCENi(s g.. Nolwn, Ms.Kan. AGE-Inn R:nMe. UNDER 1~ UNOFR i DI.Y~ 0-T ATE OF 81RTN (MO.. Doy. Yr )
<br />Indron.• J($ NYJ ,Garman,wk 3fSp«i/y/' (YnJ MO$ ~ DAYS NOUYS~ INS
<br />,, where 7, American fi b, 7o eb. ~,_ ~ ,x. July 30. 19G3
<br />C ANO TATE'Of IRTN iN neJ In U.S.A , ~_ ~CITI EN OF WHAT COUNTRY MARRIFb. NEV ER MARRIED. ~ NAME Of SPOUSE flF.i/e, q.•. noidsn n ms)
<br />nryyJ WIDOW F0. DIYORC{D 7Speri/YI
<br />-. Grand Island Ne ~Y, USA !,D Married „ Harry Bahr
<br />SOCEAt$ECUR{TYNUMRER ,USVAI OCCU>ATtON EGA.. EiM eF..o•t dens d.rrng mmr KIND OE BUSINESS ORINDUSTRY COUNTY OE DFATN
<br />' oE.nrEin kfe. swn d..errd)
<br />rz 5~-G?-1792 „a ~iousevife If76 Ovn home ,dp. Hall
<br />l~ ____~
<br />- CITY, TOWNORtOCATiON OF DEATH IINSIDF CITY tIMYT$ tiOSEITAI OR OTHER lNSTItUT10N-Hems (IFner.n eiJber, TI/NOSP OR tNST IMae.. DOA.
<br />'($P.rAY Tsr or Nai ++qi,s rM.r a.rd nvmbsrJ I Ourpa.a.'Nf.rr M, I.vvun,. (Sp«IJrt
<br />,.. Grand Islecnd ~ I4 Yes i ua 5t. Francis Medical Center ~... Inpatient
<br />RESIDENCE-STATE tOUNtt jCiTY, tO~ M•N Or lOCA110NJ STREET ANO NUMBER INSIDE CITT LIMITS
<br />I ~ ~ (Sps<i(y Ysr or NeJ
<br />1~. Nebraska F36_ Fall '.s< Grand Zsland ~ISa. 1322 W. Louise i,sR Yes_
<br />A N -NAME FtR T MIDCtT'~~ FSOTN ER-MAIDEN NAME FIRST MlObt U i
<br />,. Jacob Liebsack ), Mary Liebsack
<br />WA$ DECEASED EYE! EN U 5. ARMED FORCF3a 'INFORMANT-NAME - nElA2lONSNl1-MAIttNG ADDRESS Iireffi OR ! f O NO.. CITY OR TOw N. STATE. LIP1
<br />ry,., wv. «+..1(tfl m, ,.n tea. n.d Goa, ee .er..a.. '
<br />Ie. a _ ~ I e~Ty Bah~..,_F~u~.~e_Bd_., 1322 W, Louise Grand Island, Ne
<br />BVRiAL. Crsmarion. RemewliDAT :CEMETERY OR CRFAUiORY-NAME LOCATION Cttt OR TOWN STATE
<br />xa. 08'3.~x~ Grand I!R~ nd C m~_t.~V ~zoaGrand Island. Ne
<br />E -~$IGNAE{ftE 6 I N O. FUNERAL HOME-NAME AND ADDRESS iSi REEi O+2 r D NO. CAP.' Ot COW N, liwtf. Ile)
<br />~~r~~i-' Re.
<br />x ~ ixxL vin st n Sondermsaa F.H. ,505 W, Xoenia.Grand Island,
<br />i OATF OF iN FMe., Day, Yr) ~ DATE SIGNED {M0. Day, Yr.) j HOUR OF DEATH
<br />ai I ~°vX
<br />' ~~ ~?]a. t Y1 'ftT"1 ~tl TQ;,,~~ ~o _xdo- tab- M
<br />, DATE SIGNED fMn.; Doy. trS %NOUR Of DEATH aRONOUNfED DEAD LPRONOUNCfO DEAD(Neur)
<br />{ (Mp-Oar. Yri I
<br />e rrtl
<br />~xDk aTs3Z1. 3 j .LaH3 2 ~i7k. ~:2v P..^,?. + ~~xK: '. xdd. M _
<br />a.. w a . in.-uR.. a..w rr.a ...a « p~«. ana a.... M. M a ~o 'a p a.. e~ a . ,.e a a .n. <a...l.l . ,~, a...i «.....a .e
<br />j ~.4wN •.d ~'. ~ ow ., ..i day a T wr:d.~
<br />/ =a;
<br />ANF3 A CfRii'tiF F', SIC NE W3 PNY$:CIAN OR COUNTY ATTORNEY} 1(yp. o. pnn+J
<br />Ger~en J `irnicek, ~l?`. , 72 a P:. ~uste_r. Granr.___ -_and. ~"F' efs801
<br />REG13TWt ` J-i DATE 1tECF YED BY REGISTRAR (M _ D y. Y.) _
<br />j
<br />/ ~ ^ r'
<br />z~ae.es.R~,.,~«_e~- .rlf' ~Lii Ji~~ ~C~-L~/,C C_'` r~ ___ xc X~ fl_.r_=_r~* cif / ~J
<br />~~ n7 iMMFEl1AT 4U E~- ER ON[i dNf <AUSFE :ER e1NF FO! Int. ; b). AND (•:! ~ ~~- ~n~o~ e....s. w.« aw dw.M
<br />PART ~^
<br />c --~"iw iT~'C0~+31T~eiFNCF --~--'----_._~._. ~.a...i n....« «.«.w a..m
<br />(
<br />n1
<br />DUF TO. OR AS A CON3EQVfNCE Ot ._._._.,.__~.._~._~_:_.__ . _A__-.~_-___-_~. aa..a1 n.«..., .,.,...d d.vn.
<br />(d _
<br />A~sFOebi ~ W A3 CA32 RNIRRfD VO MlDKAI
<br />,A-'~'tS ~bYti.1~FE'~DIPf7TJ1~ f«H a as ..4n»R e. dwn !.. eu W W Trx R~ n: .t ituyt wU tnfif • T~---~1_____
<br />ii _>Et4•a.,NCT;atnF>a312mOniJli. =ISw.Ar T, },. N,. Iivµ N+R OR NORONlR
<br />Na df zE I~` J ~zv .... ., x ,
<br />AevDENr, suK+a, - +EIf. u>coet.. ~I on rF a YN:w.l,.n. D.,. r%.na.i a ~«,~n-`~`ciichRe ..o++ auuir oe`cu.Ke6 ~ .. C
<br />O! tfhDING WYE3t10AIWN ISP«.l,J ;
<br />~ NfR. ~~ 706. ~70t`_A _ i 78d .^ __
<br />tWUtY AT HOAR F OF WDRT- Ae Ian., I.rn. ••.„I. t Mm. TtOC~rXM. 51 tEEt O! R 1 D rM <Irv q tOwN 3TAlF
<br />1 SR«Ay T. « NsJ ' aa.r, i+.w.R. sw r3R«.1>r
<br />,]pE. ~70R.
<br />WHEB~~,,'~ T~j,~S,.,CI7PY CARRIES TEE RAISED SEAL OF THE NEBRASKA
<br />5<TA`TE'~DBP~ii,~13E'i~T OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A.TRU$_'COI'Y~'OF. AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPA;RTllENT OF=HALT&, BUREAU OF VITAL STATISTICS, WHICH
<br />°t'FfIS_, LEGAL llEI~OSITORY FOR CITAL RECORDS.
<br />ti ~ ~. ~ ~ d
<br />D~'$ 03E ,~E,t. STATISTICS AND ASSISTANT STATE REGISTRAR
<br />LlNtigd.t~,,~~NB$~ItlSRla .°` Issued February I~ i98S
<br />
<br />
<br />
<br />
<br />
|