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<br />WHEN THIS COpy CARRlES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN JiliRVlCES
<br />SYSTEM. "CERTJFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECO~~~:Wl!!;I.
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM. VITAL STA TISTICS ~,IJP1!;:,!!!J~I1-=-~~-o_
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. M....B. ~~~ff:.}'~. . .~.ci ~~:~~~..~..--~.t...'-
<br />
<br />DATE OF ISSUANCE . ;V1JIff'!:ii-AN~"'j.~cfoiiP~~~\ ~~
<br />
<br />LlNCO~~~E~~S~05 200510373 HEALTH A~~S::J~~~;~!~;3c;iJ
<br />'~,;~~U:~/-=
<br />85- 13184
<br />
<br />STATE Of NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH i.
<br />
<br />ClECEt'fNT':' NAME
<br />
<br />FIRST
<br />
<br />""POLE
<br />
<br />LAST
<br />
<br />5[l( -----roATE OF DEATH (Mo. Oar. Y,.)
<br />
<br />l. PATSY Ruth LESSIG 2. Female~11-25-85
<br />RACE - (..g.. Whil.. Ilack. "m.,ko.. OIIGIN/OESCENT (..g.. holian, M..;co... AGE -10.. $;"Ilda. UNDER 1 YEAR UNDER 1 O"'T DATE OF 11ITH ("10.. DOT. Yr.)
<br />I..d;o....",.)($...c;,,) O'._....lc.)(Sp..il,1 01. (Y".) MOS.. OAYS/HOUIS, MINS.
<br />_~. White 5. American " 6a 54 _ 6b.: 6<.: 7.March 3, 1931
<br />-'-'CITY AND STATE OF IIRTH (H ..01 'j.. U.$.,o\. CITIZEN Of WHAT COUNTI'l'IIMRlIIEO. HEVER MARRIED. I NAME Of s'OUSE (II wil.. giy. ",aid... "0"'.1
<br />"0_ cau..I,,) jWIDOWED.D1VORCED($Pecil,}
<br />.. Kearney, Nebraska 9_ U.S.A. 10 Married Ill. Harold J. Lessig
<br />'-s6c,...L sECURllY NUMI!R USUAL OCCUP...TlO'" (Giy. .ind 0' wo,. don. during 'fOO11 ~IHO OF luslNEsS OR INDUSTRY COUNTY OF DEATH
<br />. -_ of *ol'Jd"" Ii,.. ___" if r.'.,.d)
<br />.....u....2..Q7:-34-5193 130 Housewife Hall
<br />tiiY-:TOWNOllOCATlON Of tlEATH INSIDE crN LIMITS " HOSP O.INST 1...i.....OO....
<br />(Sp.(:i~~ ""1 0' No) gi..str..t arid tt"l'tIb.r) Olltpotie""e..... ..... 1I"41ti.,., ($peorJl.,J
<br />!k Yes 14d. St. Francis Hedical Center '4.. Emer. Room
<br />~'TY. TOWN OR lOC"'T10N STUET AND NUMBEI INSIDE CllY LIMITS
<br />(S;>.ciry_T., a' No)
<br />lk Grand Island l.5d 4318 Claussen lse Yes
<br />LAST M HER-MAIDEN NAME fIRST ST
<br />
<br />141> Grand Island
<br />IE$IDfNCf - STATE COUNlY
<br />
<br />
<br />Ub.
<br />
<br />Hall
<br />MIDDL
<br />
<br />_ . !6~_ Raymond
<br />--""...5 DECE"'SED EVER IN U.S. ...lIMED FORCES?
<br />cr.". nl;l, or... jJ~k) j (If vel. QI1'. W=1l'" and do'", ot Mr'k'lll:':iII"
<br />18. No
<br />::,- 8URj"'L.C;~"'0Iio... R...,ovoll DAn
<br />
<br />200. Burial l20bNov. 29, 1985
<br />
<br />~IA-----=-sIGNATUlf & LlCfNSE NO..&."
<br />
<br />~~-'~
<br />
<br />OAT~MO.. Do,. T,.) ~_ Z"
<br />~ 1/-7-jJs '';:!i
<br />l~ 230. l~o 24...
<br />~r.~ OAT I N 0 ("10., Oar, Y,.) ~OUI OF DE...TH 7 if!i~ PRONOUNCED DEAD
<br />t~ I / r" Fe I z 1- z. s~~ 5 ("10.00'. Yr )
<br />.3 r 23b. -- '--- J --- - -- 23< M "ll:Z I 24c ] Ud M
<br />J1 To 'he lb..... of fIt~ .,.:owl....1 d-.o.h occ"rrtd otJ............... dcue olltd p'a'. and d... to .hlt I J 5 8 I On _. bOil' of .1II0Mir'iati~ ot'ld/ol' l:ft...tiQa'i~. ,ft A'lr
<br /> opiftian _Cloth .lXC:\lrrM Of'
<br />~! t~~:t~t) ita,. ~? ~ ) ~ ~ I ~! ~ I fh. ti.... date Clncl ploc. ond cI... _ the co"..c.tl .~
<br />
<br />_ 2 ./S.G.....u.. a.d r,II.} ~_...~ ~--~ ~~ _~t!.1CJ I " 2<&" (S.g."'.r. ...01 1'''.1.
<br />---..rAMt AND ADDlfS 0' CERTi~IEI (Pl1ysICIAN. CORONER's HYSlC''''N OR COUNTY ...nORNEY) (T,p. 0' P""')
<br />
<br />Juzek 17. Bonibel Thiel
<br />I'NFOItMANT - NAME ~ "fl" T'ONSH'P - MAiLING ADDRESS (~T.UT O. ..f D. NO. CITY 011 T~~N '-'T> . .,.
<br />
<br />l~arold Lessi -Husband-4J18 Claussen Rd.-Grand6~g2Andt N]
<br />CEMETf" 01 CREMATORY N4ME LOCATION CITY 01 TOWN STATE
<br />
<br />
<br />Perk 2~. Grand. Island, Nebraska
<br />(STlUT O. ....D. NO.. C'TY O. (O....N. ST"'ff. liP'
<br />
<br />Grand Island, NE.68801
<br />Ii UI OF DE...TH
<br />
<br />2<&b.
<br />PRONOUNCED DEAD (Hou')
<br />
<br />M
<br />
<br />2L__])uane Baker
<br />REGfnu..----n--.
<br />
<br />
<br />Medical Center,
<br />
<br />Crand Island, NE. 68801
<br />: DATE RECEIVED IT REGISTRAR /Mo.. Oar. Yr.)
<br />
<br />~
<br />
<br />DEe
<br />,
<br />
<br />2 1985
<br />
<br />26a. (Sj.nG'~'.J'"
<br />27. IMMEDIATE CAUSE (ENTfI
<br />"'IT ~ _
<br />, rl.., ~L
<br />(..I . a,,"Y ca-<<, <.y
<br />" DUE TO, 01 AS A CONliEQ NCE OF,
<br />..-J..... -- <:.' -. /_ -t--
<br />(b, /;,'1L.rt_cJ;J.-<.v-':: /'-c-<--<-j-c....."..'^"..~,I C,,-r----<.<:..~,.,,-:
<br />DUE TO. 01 AS A CONSEQUENCE OFr
<br />.d .-'-,/; . -.
<br />/ -.'" ., ',^ .JL.(? "".... f C' .f.. ;J..(" <'l ~
<br />(c)<..........t.t.......,.'...~ - .
<br />PA'iT--;;'ifHEa SIG~lflC.JlTCOND'tIONS- C....di.i.... ,..."ibv.;.g 10 dea'h ~.. ..., ..I..ted
<br />1\
<br />
<br />Intervol b......... Oft.... Ofttl 4eo*
<br />
<br />c.'- -t,.'ui ",r-
<br />
<br />'".._I b_en ....... ..... _Ill
<br />
<br />1."_1 b_ .......... _..
<br />
<br />300.
<br />""INJUn-., WOll~"
<br />tSpac:ifr 1..l .,. Ho'
<br />
<br />3Gb. 300:
<br />Pl...ce Of IN}U.Y - ""1.._. fur... ....." Ion......,
<br />....ic. buildinG_...r. fSp4Ki',J
<br />
<br />
<br />W"'S 0.$11 "fellto TO Ml!1JI(:"'L
<br />EXAMINE. 011 COIONII
<br />IS_;" ,.. ", N.'
<br />29
<br />
<br />ACCllIt,.:;;-iVICIOf. l4O.WCU>>:. UNIltT. lo...n Of INJu.y I...... 0.... Yr.!
<br />OIl PINIllNG INVfSTIG...T\ON tSp..il.,' I
<br />
<br />3~.
<br />
<br />ST.UT OII....D "....
<br />
<br />CITY 011 TOWN ~T...n
<br />
<br />~Q..
<br />
<br />301.
<br />
<br />._._~~ T' ~-_. 1 - J~,-:"~ lII-' ~~.~~'Ia!'~~j..__~ti'>\S.o.1-"<I'~a".:"'_"'.Mlr~:..-o<'-"'~'''''--'.'I.'~"-_.,..,,., ~.~"."'.."_.~.,-""'..._".,
<br />
<br />'._,,~:~~ TrrrlllTW'
<br />
<br />. " ::~, \,~",. , ",
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