|
~~ ~
<br />
<br />~~ ;~ C
<br />Z n =
<br />C ~ -.-. ~ ~ m
<br />_
<br />~
<br />=
<br />~ 7 -~--~
<br />~ ~ ---!
<br />~ ~ C7
<br />o
<br />~~ r
<br />n ~ ~
<br />0
<br />- ~
<br />~ ~ ~ = p ~ +,
<br />o C;,D z
<br />~'"'
<br />~ ~ c~ va
<br /> ~
<br />Q ~ ~-~ m .~__...••
<br />~i ~ ~
<br />T ~,
<br />c ~ ` c~ ~ ~ m
<br /> ~~ ~
<br />
<br />~~
<br /> FILE: 09-5882
<br />_-.
<br /> Lot Six (6), in Block One (1), in the Replat of Riverside Acres, an Addition to the City of Grand Island,
<br />
<br />Hall County, Nebraska. ~
<br />~ ~'
<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIG~AC R COkD'iOdV
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VIT~At ~Rf~(~JR'LL~; W
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. ` ,
<br />~`~.w~,
<br />DATE OF ISSUANCE ~~ °;,
<br />. .
<br />• STA~ULEY QOPER
<br />AuG 17 Zaa9 ~ O /~ n (y ~ (~ ~ ~ A$SISTAN7'~$7`ATE~F~E~,ISTRAR ,',
<br />V .71J E7 DEP/~I,R~M~T b~ ~!L'AGTH A{~ID
<br />LINCOLN, NEBRASKA HUM~W'~$EI~VICES ,', '
<br />>. ~;
<br />STATE OF MFdRASKA -- OLPAWTAIEli1T OF HEILLTH - "~ •
<br />f
<br />+. pECEDENT -NAME FIRST MIDDLE LAST 2. SEx 9. DATE CF DEATH /Mol'Ir4 tlb•, Yrrl
<br />Wilmette Ashley Proffitt Female October 25, 1991
<br />a. CITY AND STATE OF BN+TH /N npt in U.S.A., nwrttr cowwy) 5a. AGE -Leal BiAhday 6. DATE DF B~+7H tlipMp. Wy, YrIrJ
<br />{vra.l 56. MOS. DAYS 5c. MINS.
<br />Sutton Nebraska ~ A 5, 1918
<br />7. BOCUI $E
<br />RITV NUMBER tM. PLACE OF DEATH
<br />CU
<br />~~ ~ l] ER/CylpNNry ^ DOA
<br />-
<br />n
<br />5~-V~"`~`tG35 ~ T R:
<br />O HE urakq Hwna Q Rn~dence ^ OVIar ($p/C''7'1
<br />~., F~1CK.1*V-Hama /M nor arraaiaprr. Dl+'r Dlreai~a.+ aRW,'aWAh>m16 LO@Af1g1'a9P'BEA'M"... ... ..,'., , Dd.~ CITY1MT ~. T11
<br />lSPraMy Yrr «Me) ~
<br />St. 1?`,xancis Medical Center Grand Island Yes Hall
<br />9a. RESIDENCE -STATE 94. COUNTY pc. CITY, TOWN DA LOCATION ad, tiTREET AND IIUAA6EIM (/npygYlg j,{n Ctrdy 9r B~
<br />Nebraska Hall Grand Island 1303 S ecoach Rd. a~F~w
<br />+D. RACE - N-4• ~. ~~ AmMiCan Indian. ++. ANC88TRY (%.y.,~+rl, Mexican. German. ak.) +2. MARRIED,NEVER MARRIED. 13. NAME OF SPOUSE /M rIMA OM a1WwI AAwN
<br />Mc.l lsPacNYI /SprcNyl WIDOWED. DIVORCED /$peq'y)
<br />White American Qlv Married J.A. Proffit
<br />+4i U':'.:^~ OCCUPATION /GWr kindW aiork ddla durwp mpaf t4b, KIND OF BUSINESS INDUSTRY .`
<br />tlr anrrq rr, rwn . ~ar~ty Ekrnrryary « Brtlorldry (¢+x1 I CaMBr n { w w
<br />Housewif
<br />\Q1
<br />~~a,
<br />'
<br />e
<br />Domestic
<br />2
<br />12
<br />+6 FATHER -NAME FIRST MIDDLE LA$T +7. MOTHER -MAIDEN NAME FIpB+` MIDDIE I.ABT
<br />Harold L. Ashle Helen ~ A.
<br />"0. WAS DECEASE6 EVER ri U.S. ARMED FpRCE&? +Y. INFORMANT .NAME - MAILq/0 ADORE$$ (STREET OR iLF.O. NO.. Cf'h' OR 70MIN, BTA ~ry
<br />(Vas. no, « unkl (K yei. ~e NY antl dNq W larviCp{
<br />No J.A. Proffitt M.D.-1303 S ch
<br />201ti Bl1R1AL Gamalnn.Ramoval,
<br />DanMOn 20b. DATE 20c. CEMETERY OR CREMATORY • NAME 20d. LOCH CITY OR 11'~
<br />Cremation Oct. 25, ].991 Central Nebraska Crc~naltion G
<br />21. EMBALMER - SIGNATURE i L1CEN5E NO. 22. FUNERAL HOME -NAME AND ADDRESS w IGTREET OR RFA. MO., CITY OR TOWN, $FATE, ~
<br />Not Eimbalmed Eel-Butler s 1 2
<br />? p~ IMMEOIA'[E CAUSE (ENTER ONLY ONE E PER LINE FOR {a{. {p{. AND (e11 I MMNrB1 py~ N~
<br />I
<br />I I
<br />Dl1E TO.OR A$ A OUENCE OF: 1 MKer.rl rtwai and +ae,Bl
<br />~ t
<br />I
<br />DUE TO, OR CONSEOl1FJiCE I rrrtM116erard ewwl ear dares
<br />I
<br />I
<br />OTHER $IGNtF1CA1+T CONDITgNB - CtxMltiona eantri6utlnp ie daaln but rq1 ralelad PART IM IF FEMALE. WA$ THERE A 2K. AUTOP PS. WA$ OA,9E
<br />P'~
<br />.. _ PRE6NAIJCV ri THE PA87 3 ~TH$? / Abl t+N1Yi71ER OFt
<br />IS
<br />I^11' Y
<br />~
<br />ee O
<br />Pr
<br />" Yaa C7 MP Y
<br />26a ACC{DENT. SUICIDE. HOMICIDE.. UNDET.. 2lb. DATE OF INJURY /Ab..Day. Yy 28c. HOUR OF MUURY 2Sd. DESC HOW pWRV OCCURRED
<br />OR P£NDINO MIVESTKiIATION /Spadry/
<br />ZEe. INJURY AT WORT( 2eI. PLACE OF INJURY - Al Iltlrrla. yrnt, atraaL +aL10rY, 20Y- LOCATKNI STREET OR R.FA. NO. CRV OR TOWN $TA7~
<br />lSpncry Yn «Nnl alike W~Idvq, Nc. 16pocayl
<br />27t DATE OF DEATH (Mb.. Dry. ri.l ~ .~. 2da. DATE SK+NED /Ma. Dry. Yr,) 2fb. TJkE OF D£AT'H ...
<br />
<br />276. DAT
<br />-~ IMP.. d/Y. Yrl 27c. TIME OF DEATH ~
<br />2lc. PRONOUNCED DEAD lAld-. Lyl' vrJ 91d. PRGNOUHCE6 DEAD pNaw/
<br />y
<br />~
<br />~
<br />a ~ 27tl. 7tl dIa 6rN d mfr knere txxunad N aM b rIe a 20a. On pIa 6aaie d taramNlaMtln atldr«
<br />~~ daaM bbdslN fl
<br />talnelai /alatl- S 7s 1M Gme. d+M arM Plan and due b t/1 q,
<br />auva and T and T
<br />29a. OW TOBACCO USE TD THE 7 7 30a. HAS ORGAN OR TISSUE DONATION BEE ? 906, WAS CON9ENt' GRANTEb'!
<br />C] YES C7 UNKNOWN p VES NO p YES
<br />3+. NAME AHD ADDRESS IER {PHYSICAN, ER'S PHYSICAN OR COUNTY ATTORNEY( C!1'Pa a
<br />Robert I f M 727 N. Custer, Grand Island, NE. 68803
<br />32a. REGISTRAF
<br />376. DATE flLE0~,1
<br />- -.
<br />• ! 1 ~ L^-.
<br />
|