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<br />STAn: 0.. NEBRASKA-DEPARTMENT Of' IIEALTH
<br />003638 Bur....u of \'it.1 StatistiC". f~
<br />CERTIFICATE OF DEATH.! ,; ,..
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<br />OKEASfO NAJritE
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<br />Ann
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<br />SEX 04ff Of DEATH I ...OHf"', on, "'.... I
<br />I Fe~ale i, Deeember 23. 1974
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<br />RACE _'fI. ..,C;IlO, """II'C"'M I"'P',"'I, AGE I"" -- VNOIJ, ,_ ".., _ ,II""''' , "'" DATE Of IllffH' ...c.>>oI.... D"~, lCOUNf~ Of DEATH
<br />He r 'He",., Whi te sl~""04Jll'''~1 :;';'0;- r-;;;; T:;;o~sr:;-.;..- ,'Aug. 10, 19~9 I,. Ball
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<br />em, ro'W'N, O. LOCAnON OF DEATH '''SlDI01'l' llM'" HOSl"ITAl OR omu INSTITUTION NAME ,11 HOI!" flfMlI, c."' 1o'''''.ufO H~fI'
<br />Grand Island r"""'Y'e~'"" st. Francis Hospital
<br />~"'Tf Of tUfttl II' "'0' IN \I,l .." 1'4.'" /CITIZEN OfW,coUNTiY-- :".iIf6, NEV'E..ii'Aiiiui:---m_vfVNc SPOUSE'" Will, G"'" _IP'N """" 1
<br />. l~ebraska (0\1......11, USA ;IDO~~OIVI(I''''!lI Orval C'o Baker
<br />SOCIAL SECURITY NUMafll "--- USUAl"Ce, CUPATK>N ,"""';;;';;!-"wo.. O;;;;;;;;;;;;;;-;O"-O'T';!o()f IU'"'''' "" .NOUST" -
<br />U 540-32-6233 l:o..!~ ItIbmemaker \'.: 1>> Heme
<br />RESIDENCE STATE - COUNTY - CITy TOWN, OlllOCAJ1ON ---~ INS'Of (t" u.urs STun AND NUMIfR
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<br />l..l~ebra8ka Gra..v:J.d ,,; Yes 14,
<br />FATHER NAME
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<br />(oj Cardiac arrest '"
<br />IlU, TO. 01 A\ A <O..UO\II..O or
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<br />CO"OlflO"$, I' A"T,
<br />.....'C.. ,,..'OJ IlU 10
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<br />(h} Pulrr.on:"ny E311oo1us '"
<br />O;:;;-;O:--o'~;-;(O;;;iO"'I"CI-O'-- ~~----
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<br />l~l Exogenous obesi ty '"
<br />,.....T II OTHfI SlGNIHCANT CQHDlTlONS- (ONOIIION$ CONTIIIWTlNG TO P~"'TH IUT "'01 Ifu.:l~-I-.~~;;-~~l~ w...s T,HUt A .
<br />TO c...un GlVtN IN !'AIT 1(0) 'tfGN..",<<;Y IN hHe ,"'" ) MOHlttS1
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<br />ACCIDENl, 5UICIDf:---:-HOMI~T5:\Jr6fiNKii"r7;O~;;;;. !HOUI1----o iHOW IN.;
<br />~ UNOt:T'fRMINEO Itl'tC"TI 11'011 110< M !1Qd
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<br />INN.Y AT WQ<<lC I "LACE Of lNJlij!Y .1 """'. 'HMo 11IH!, ';.('10U i loc....no,.. , U'UI O. I , ~ "0. (,..... O. lOW... \"'111
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<br />CEflIFICATION-
<br />::"!>l:::~:~:~~.f~: 12-19-7.4 f~ll' 12-23-71}
<br />cEi~"::MWK...iTiAMINEI ORCC)iONiRO;;-,--;'--;;\,-,'-o.~----
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<br />n. W. j. Lawton
<br />MAiliNG AOOU:SS (Unflf_
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<br />~=~;; ,ClfMATION. ItfMO......t
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<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 />VITAL RECORDS.
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<br />DIRECTOR~ BUREAU OF VITAL STATISTICS
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<br />I ssued ,June 29, 1984
<br />LINCOLN, NEBRASKA
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