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<br />ENTERED AS INSTRUMENT NO
<br />
<br />o 2 0 0 902 0 0 Z
<br />
<br />STATE OF NEBRASKA)SS
<br />COUNTY OF HALL ).
<br />
<br />2009 r1RR 20 API 10 15
<br />
<br />j(~ ;tf~
<br />REG OF DEEDS
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<br />CASH
<br />CHECK '- S-:~)
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<br />REFUNDS:
<br />CASH
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<br />200902002
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<br />
<br />Part II
<br />
<br />[J:e-
<br />State of Nebraska General Ntltal'ial ............
<br />.1:. EILEEN McM1LLANTMV ..... ............
<br />Comm. Exp: 06-14--<<]ensus act No.
<br />---~~
<br />
<br />200902002
<br />
<br />_.3189
<br />
<br />STATE OF NEBRASKA - DEPARTMENT OF HEAI..TH
<br />BUREAU OF VITAL ST A TlSTlCS
<br />CERTIACATE OF DEATH
<br />
<br />1. DECEDENT. NAM E
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />LAST
<br />
<br />2. SEX
<br />
<br />3. DATE OF DEATH (Monrll. Day. Year)
<br />
<br />Rosemary
<br />14. CITY ANO STATE OF iljRTH (II not in U.S.A, n.... """"Iry]
<br />Norfolk, Nebraska
<br />7. SOC~AL SECURITY NUMB ER
<br />
<br />Ann
<br />
<br />LeMunyan
<br />
<br />Female
<br />
<br />April 4, 1993
<br />e. DATE OF B~RTH (1./00111. D.y, Y.ar)
<br />
<br />8b. FACILITY. Name
<br />
<br />
<br />ad. INSIDE CITY UMITS
<br />ISpocify Yes or NoI
<br />Yes
<br />
<br />5a. AGE. Lasl 8fr1hday
<br />jYrs.1
<br />41
<br />
<br />N
<br />5b. MOS. I
<br />I
<br />I
<br />
<br />5<. HOURSI
<br />I
<br />I
<br />
<br />DAYS
<br />
<br />t.WNS.
<br />
<br />October 31, 1951
<br />
<br />~ cjl;np'liOflt 0 ERIOLllpa/ient 0 OOA
<br />OTH ER: 0 Nu"inq Hom. 0 R.....ne. 0 OIho< (Spo<:ify)
<br />eo. ClTY, TOWN OR LOCATKlN Of DEATH
<br />
<br />506-76-2295
<br />
<br />
<br />LAST
<br />
<br />St. Francis Medical Center
<br />
<br />Grand Island
<br />
<br />90. RESIDENCE. STATE
<br />
<br />
<br />Gail K. LeMunyan
<br />
<br />90. CITY. TOWN OR LOCATION
<br />
<br />90. INSIDE CITY LIMJTS
<br />ISpedIy Yes or No]
<br />Yes
<br />
<br />13. NAM E OF SPOU SE (It ..i... give maidon namel
<br />
<br />Nebraska
<br />
<br />Grand Island
<br />
<br />1-0. RACE - (e.g., White, Black, American Indian.
<br />ote.I(Spocilfl
<br />WhIte
<br />
<br />1 t. ANCESTRY (e.g.,ltal:ian:, Mexican, German. etc.~
<br />(Specify] .
<br />AmerIcan
<br />
<br />140. USUAL OCCUPATION (Give Idnd o!lWNk done durin9 most
<br />af worIdng Ji/o, .ven if ro1Ired)
<br />Registered Nurse
<br />
<br />1411. KINO OF BUSINESS INDUSTRY
<br />
<br />Collogo 11-4 or 5.)
<br />5
<br />
<br />Nursing:
<br />LAST
<br />
<br />Hospital
<br />
<br />17. MOTHER. MAIDEN NAME
<br />
<br />
<br />STATE
<br />
<br />16. FATHER. NAME
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />FIRST
<br />
<br />MIDDLE
<br />
<br />Elmer A.
<br />
<br />18. WAS DECEASED EVER IN U.$. ARMED FORCES?
<br />No' no., or unk.j III yes, give war al1d daleS at servicesl
<br />
<br />Doris M. Slaymaker
<br />ISTREET OR R.FO NO.. CITY ~E?~N. STtiS~53
<br />Gail K. LeMunyan-4264 Manchester Rd. -Grand Island f
<br />
<br />
<br />20b. DATE
<br />
<br />200. LOCA TlON
<br />
<br />CITY OR TOWN
<br />
<br />7, 1993
<br />
<br />St. Joseph's Cemetery
<br />22. FUNERAL HOME. NAME AND ADDRESS
<br />
<br />Atkinson, Nebraska
<br />ISTREET OR R.F .0. NO.. CITY OR TOWN. STATE. ZlPI688 0 1
<br />
<br />1123 W 2nd St., Grand Island, NE
<br />
<br />#d~3D
<br />
<br />Apfel-Butler-Geddes,
<br />tAT CAUSE [ENTER ONLY ONE CAUSE PER LINE FOR l'I.lbl. AND lell
<br />lal (nra:u,;:"~ v(OA.Jt~N
<br />
<br />DUE TO. OR AS A CONSEOUENCE OF:
<br />
<br />Interval betweet1 onsel and ctea1i1
<br />
<br />2.nvn7}.,j
<br />
<br />tmerval berween OMel ana dea.O'l
<br />
<br />b
<br />DUE TO. OR AS A CON SEOUENCE OF;
<br />
<br />InteNa~ between onsel ana dea:.Itl
<br />
<br />e
<br />OTHER SIGNIFICANT CON DITIONS . CorKIilion. cxmlribUling ll> -... but "'" fO!ateO
<br />Pf? lier. h&tL
<br />
<br />26a. ACCIDENT, SUIC~ . HOMICIDE, UNDET.. 26b. DATE OF INJURY (Mo.,Day, Yr.]
<br />OR PENDING ~NVESTlGA TION (SpociIy)
<br />
<br />
<br />24. AUTOPSY
<br />(Spocify Y.. or NoI
<br />PC
<br />
<br />25. WAS CASE REFERRED TO MEDICAl.
<br />EXAId~NER OR CORONER?
<br />/Spocify Yes or NoI ,.J D
<br />
<br />~ 20.. IN.J<J RY AT WORK
<br />(Specify Yes IN NoI
<br />
<br />STREET OR R.F D. NO.
<br />
<br />CITY OR TOWN
<br />
<br />STATE
<br />
<br />270. DATE OF DEATH
<br />
<br />28.. DATE SIG NED (Mo., D.y, Yr.]
<br />
<br />2Bb. TIldE OF DEATH
<br />
<br />ZTe. TIME OF DEATH
<br />OC\.{O
<br />
<br />~~~
<br />i~~>-
<br />J~~g
<br />.8~5
<br />i<f?8
<br />85
<br />
<br />288. On the basis at examirlation and/or investigalioo. in my opinion death occlJffi!ld at
<br />1I'Ie lime. cIat8 ami ptace atId due to ttle caLJ:Seis] Slated..
<br />
<br />2Bc. PRONOUNCED DEAD (Mo.. Day, Yr.)
<br />
<br />2ad. PRONOU NCED DEAD (Hour)
<br />
<br />M
<br />
<br />DYES
<br />
<br />&::Iio
<br />
<br />~
<br />
<br />30b. WAS CONSENT GRANTED?
<br />DYES
<br />
<br />!l"No
<br />
<br />o UNKNOWN
<br />
<br />DYES
<br />
<br />31. NAME AND ADDRESS OF CERT1FIER IPHYSlCAN. CORONER'S PHYSlCAN OR COUNTY ATTORNEYI (7_ or Prin~
<br />
<br />Dr. Anne K. Morse
<br />32a. REGISTRAR
<br />
<br />729 North CUster Grand I
<br />
<br />
<br />321> DATE FILED BY REGISTFlAR (Mo.. Day. Yr.]
<br />
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