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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUM)ftEli3 <br />SYSTEM IT CERTN/ES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD DN -FILE_ WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS AMOK 1IWe _1S <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. _ _ <br />DATE OF ISSUANCE <br />JAN 1 9 2005 <br />LINCOLN, NEBRASKA <br />PHS- 7n(VS) REV. 4 -57 : <br />DEPARTMENT OF PUBLIC HEALTH, <br />EDUCATION AND WELFARE <br />'6T&TH NA. 19E <br />200501218 HEALTH AND <br />STATE OF NEBRASKA <br />DEPARTMENT OF HEALTH <br />Bureau of Vita! Statistics <br />CERTIFICATE OF DEATH <br />111LEY�, WOPA <br />`ANrsr ►st <br />MA 5 3 <br />s = <br />-0 0567"6 <br />STATE FILE NO._ .... .. ... ........................ <br />1. PLACE OF OEATN 2 <br />2. USUAL- w[BIDENCE(WAw. leered tied. <br />a. COUNTY n a <br />Nebr. b <br />_ <br />G LENGTH OF STAY IN lb e <br />o <br />o cn <br />� <br />_ Grand island <br />d. NAME OF (If not in hospital, Five street address) d <br />d. STREET ADDRESS <br />Im <br />rn Z <br />e. IS PLACE OF DEATH INSIDE CITY LIMITS? YEQ0 NO 0 e <br />cry <br />° <br />o -I <br />C D <br />o <br />R <br />no <br />3. MAME OF First Middle Last 4 <br />4. DATE month Day Year <br />DECEASED O <br />OF <br />5. SEX 6 <br />6 COLOR OR RACE 7 <br />r\3 <br />8 DATE OF BIRTH 3 <br />3 AGE (In years F <br />F UNDER I YEAR JE tmIDER 24 NOS. <br />7- <br />1>r.s <br />Female h <br />White � <br />�y 2 <br />2 -24»1$ 8 t <br />t r <br />10a. USUAL OCCUPATION (Give kind of work dome 1 <br />10b. KIND OF BUSINESS OR INDUSTRY 11. B <br />BIRTHPLACE (Slate or foretpn country) 1 <br />fT, §`_ <br />. <br />/urine most of working life, raven if retired) V <br />Variety Store O <br />O <br />_ <br />n <br />�, <br />14. NAME OF NUSBA14D OR WIFE <br />Leo Hollstein A <br />�, <br />► <br />z <br />cr1 <br />17. INFONMANT Address <br />l Yew we. a un4w.rw1 (!1 yr.. tnr ,oar a deers of aernal NO L <br />Lyle Batie, Urand Island. Nebr. <br />18. CAUSE OF OEATN (Enter only one cause per line for (a), (b), and ( ] INTERVAL BETWEEN <br />PART 1. DEATH WAS CAUSED BY: 0115ET h <br />T <br />CD 3 <br />• <br />Conditions, iJaRY. DUE TO (b) - +�� --_.. ._.. •_..` '= <br />I i; <br />which pave ,I.- <br />I. V <br />r ; <br />~ <br />r <br />_ <br />C; j <br />r D <br />('• <br />W <br />N <br />D <br />CO <br />Cn <br />z <br />r' <br />0 <br />r� <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUM)ftEli3 <br />SYSTEM IT CERTN/ES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD DN -FILE_ WITH <br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS AMOK 1IWe _1S <br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. _ _ <br />DATE OF ISSUANCE <br />JAN 1 9 2005 <br />LINCOLN, NEBRASKA <br />PHS- 7n(VS) REV. 4 -57 : <br />DEPARTMENT OF PUBLIC HEALTH, <br />EDUCATION AND WELFARE <br />'6T&TH NA. 19E <br />200501218 HEALTH AND <br />STATE OF NEBRASKA <br />DEPARTMENT OF HEALTH <br />Bureau of Vita! Statistics <br />CERTIFICATE OF DEATH <br />111LEY�, WOPA <br />`ANrsr ►st <br />MA 5 3 <br />s = <br />-0 0567"6 <br />STATE FILE NO._ .... .. ... ........................ <br />1. PLACE OF OEATN 2 <br />2. USUAL- w[BIDENCE(WAw. leered tied. <br />a. COUNTY n a <br />Nebr. b <br />b. CITY. TOWN. OR LOCATION G <br />G LENGTH OF STAY IN lb e <br />e. CITY, TOWN. OR LOCATION <br />Grand Island _ <br />_ Grand island <br />d. NAME OF (If not in hospital, Five street address) d <br />d. STREET ADDRESS <br />HOSPITAL OR <br />INSTITUTION Lutheran Hospital 5 <br />510 west 8th St. <br />e. IS PLACE OF DEATH INSIDE CITY LIMITS? YEQ0 NO 0 e <br />e. IS RESIDENCE INSIDE CITY LIMITS? NSO f <br />f. FARM RESIDENCE? YES <br />no <br />3. MAME OF First Middle Last 4 <br />4. DATE month Day Year <br />DECEASED O <br />OF <br />5. SEX 6 <br />6 COLOR OR RACE 7 <br />7. MARRIED ❑ NEVER MARRIED ❑ 8 <br />8 DATE OF BIRTH 3 <br />3 AGE (In years F <br />F UNDER I YEAR JE tmIDER 24 NOS. <br />Ma.w 1 <br />1>r.s <br />Female h <br />White � <br />�y 2 <br />2 -24»1$ 8 t <br />ta%rrhdor) M <br />10a. USUAL OCCUPATION (Give kind of work dome 1 <br />10b. KIND OF BUSINESS OR INDUSTRY 11. B <br />BIRTHPLACE (Slate or foretpn country) 1 <br />12. catzEN OF WHAT Camay? <br />/urine most of working life, raven if retired) V <br />Variety Store O <br />Overton, Nebr. _ <br />_ <br />13a. FATHER'S NAME 1 <br />13b. MOTHER'S MAIDEN NAME 1 <br />14. NAME OF NUSBA14D OR WIFE <br />Leo Hollstein A <br />Almira Taylor I <br />I Milton E. Batie (d*c.) <br />15. WAS DECEASED EVER IN U. S. ARMED FORCES? 1 <br />16. SOCIAL SECURITY NO. 1 <br />17. INFONMANT Address <br />l Yew we. a un4w.rw1 (!1 yr.. tnr ,oar a deers of aernal NO L <br />Lyle Batie, Urand Island. Nebr. <br />18. CAUSE OF OEATN (Enter only one cause per line for (a), (b), and ( ] INTERVAL BETWEEN <br />PART 1. DEATH WAS CAUSED BY: 0115ET h <br />i� r, IMMEDIATE CAUSE (a) _ ^I`- <br />Conditions, iJaRY. DUE TO (b) - +�� --_.. ._.. •_..` '= <br />which pave ,I.- <br />I. V <br />dating the under- DUE TO (t) _ <br />_ <br />Fractional Lot Seven (7) and the Westerly Six (6) Feet of Fractional Lot Eight (8), in Fractional Block <br />One Hundred Thirty -Nine (139), in Union Pacific Railway Company's Second Addition and Fractional <br />Lot Seven (7) and the Westerly Six (6) Feet of Fractional Lot Eight (8), in Fractional Block Eight (8), <br />H. G. Clark's Addition to the City of Grand Island, Hall County, Nebraska <br />