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<br />I <br />83';';;' 005391 <br /> <br /> <br />PECEOENT -HAM <br /> <br />{ <br />\'! <br /> <br />20<1, Grand Island E <br />I$TU T 01 ..'.0. NO.. City 01 TOWN, SIAtl. II') <br />"Apfel-Butler-Geddes 1123 \~ 2nd St. Grand I~~~Ra <br />DATE SIGNED 1M". ODJ. Y,.} HOUR Of DEAtH <br /> <br />NE <br /> <br />2.cb. <br />,RONOUNCED DUD fHololr} <br /> <br />.. <br /> <br />", Fred W. <br />.RfGlstRAl <br /> <br />1&c,.tSigllOtwo,.," <br />27. IMMtDlAtE CAuse <br />PARt <br />leI Acute Myoc:ar al Infarction <br />DUi TO. oa AS A CONSEQUENCE Of. <br /> <br />'" Hypertensive Cardiovascular Disease <br />OUi TO. OJ; AS ... CONSEQUENCE Oft <br /> <br />Cd Diabetes Mellitus <br />~A.T OIJ111JIGNlfl(ANt CONIHftOttl-C <br />II <br /> <br /> <br />: .11....... .~... .......fMI ..... <br />i Immediate <br />I &.............._.......tI..... <br /> <br />i Years <br />. ..._....110.__...-.4... ~_. <br /> <br />: Years <br />WAS C...Sf. Uff~ItU} to MIOfCAL <br />tXAMlHt:l Oll: cotOIJU <br />tSpiHtlrl'....H.J <br />2'1. No <br /> <br />:JOa. <br />JUJun At WOf;tt <br />f~i',r.....NeI <br /> <br />ST.UlO.....O...... <br /> <br />tin Ot fO..... $I.u. <br /> <br />.... <br /> <br />... <br /> <br />',I <br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE ABOVE 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 />vir ORDS. <br /> <br /> <br />Issued September 8, 1983 <br />LINCOLN, NEBRASKA <br /> <br />! <br />.' ~~ <br />J <br />,~ <br />0' <br />,I <br />, i <br /> <br />\, .1;-t1' <br />,j. , <br />; '1 <br />. I 11;j 1 <br />~'l' , <br />{, ~ <br />'J <br /> <br />\ <br />,i <br /> <br /> <br />" <br /> <br /> <br />t. <br /> <br />, <br />'J <br /> <br />i'..' <br />/" <br />I <br />