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<br />6UREAU OFYITAI STATISTICS 1. E] p
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<br /> CE EDlN -NAM Ft M D lF E% DATE F DEA1M (MO.. Day, Yr.)
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<br /> RACE -1•p. h' •. SIO<k
<br />Aw. Non ORIGfN/pESCENT( 9 holran. Meaxon, A E-tMr R.nhdaT UNDER I. TEAR UNDER t DAT .OAT OF IRTN (MO„Day, Yr.}
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<br /> a,~L° s r I t ea eb ~ e. _ iT ?an 20, 194Q
<br /> CIIT AND STATE O/ RIRTH (N war in U.f.A, IEN OF WMATCOUNTRY MA D, NEYERMARRtEO, lIAME.OF SPOUSE'(II T g mdid.n nomP)
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<br />USUAI C)CCUPATION(Ci.R hind of rah dor».dunnq ndfr. KINDOf 6UStNE530RINDU3TRY COUNTY Of DEATH
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<br /> CITY, TOWN ORIOCATION OF DEATH .INSIDE CI1TlIMITS..MOSPiTAI OE OTHER iNSTITUIION:-.NamR.flf nal.,n RiMar,. UNOSR. OI MfT: Ineke•. DOA.
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<br />I NAM( AND ADluFE35. 01 CERTIFIER (PHYSKtAN:.C BONER'S. PNYS/CIANOt COUNtt ATTORNET7 (Iypa or fr~nU
<br />,, Gordon D. FiancisR Ni.-D.-7IO Si. Koeni - Grdnd Island Net 68801 -
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<br />I7.. IAwE A E GAUSE , f FEE ONIYONf CAVSf PER LINf FOR la), (b), AND tell 1 b.r..... ed,.r dnd d.a•h
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<br />,,, Asphyxia due to aspiration o~ vomitus 'minutes
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<br />DUE `O. JE Af A CONSEOVENCE Oh -~ x...01 b.ti.. end v.a~.
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<br />W$EN THIS.COR~f CARRIES THE 'RAISED-SEAL OF THE NEBRASKA
<br />STATE DEPAKTMENT OF HEALTH, IT CERTIFIES THE'ABOVE TO BE
<br />A TRUE COPY QE AN ORIGIhAL`RECORD ON FILE WITH THE STATE
<br />DEF:*RTME2iT aF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS°Tk~£~,LEG~T,•,DEPOSITORY FOR 'VITAL RECORDS.
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<br />DIRECTOR OF VITAL STATISTICS AND ASSISTAb'T STATE REGISTRAR
<br />LINCOLN, NEBR4SKA Issued Fet,ruary 21, 197?
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