200908530 - Laserfiche WebLink

Browse

' STATE OF NEBRASKA, WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAR-FATEAOI .bti'4,d`L+l k A114 HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF TWW ,t RAG .. OR'f, 0i , FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERS I fS; id A OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS DATE OF ISSUANCE r OCT 21 20M 200908530 ae�Rrt��STATE r 9F M� t AXb LINCOLN, NEBRASKA xr�► iaa��Me�au�rnrrrrar�r .+'a�t�w�rre[av�sn,� �jC�(��" VfIAL ftATISM V y7 iJ V cffi21W%rAT1znornFAT9 ,. NAME mv am . P�rN PaRlNrl wNwaPNaalaw Stroke Albert Dran Goodwin AArW Aw.wl irM aw d+Yh Mafia May 15, 2000 M M 1 DAY f. Ca,', wr1 w. A pammun Art *pWr,1 •Lad 47 wAftASE TO MEVIDAI E%AANNER OR CORpNE+K' t " I Halsey, 2fabraalca "�' 76 " '`Ne Maly 24, 1923 508 U 3681 M �IACi «ON!IT.4 ❑ Nww+ Ole 13 W "N. M i i. 1110WATWOM 2f1 PLACC OP MIIIIIIY- i1 .yPn. ,IrN1.lk(pY 0IIIIIIIIIIIIIIIIII ❑ R ooa FACIUTY•M,N, y" E] No . OIANi TH M Grand Island „A ®1* ❑ Hall go, RESIOEMM - STATE f! r05W is CITY.70MI OR LOCATICIN 915MMIANDMAWEk A w M L +',•,; Neb'rat Hal Y r C) 10-PACE-W101111 11 12 J2 "WO f'i W0011101111D Ii 1MIIIIIECIF VQ= tint 0 0 RIO aC11ap,pty) Whites 18parfil 2fc PIgN01NICE0 DEAD /M1 aY. W! KUM L_I Drr. D Bonnie lkzim 140. USUALOCCL*,AT1DN laAw /odMNaA dIlMIfwYATp,1 'fie, KIND OF SLONES50MUSM Is ERCAT1 N ofddrAW MR NMd 941"m lHapgfteturiag 86NAM1q Y 8Kaaa7 0-1A OMNA IT AF r, Laborer , tS. FATINLa NAME MIDDLE LA ST 1 MIIEN DT FIIIST vv= dec amen Milton Q _ 1f. WAS ECeAM EVER w US ARMED FORCES+ Igo INFORM WT • NAME IYAR.noor RMd.4wNriaptlalaaawlAwal Tft on _ _ — USE CONTMiTE TO TmF ftww sOe IIAB TISSUE DONATION lEEN r16 * MAR1Np Cm N NO. CF1.1 OR TUPM SA ❑ YEs ® No " ❑ wo om ❑ YEs 92 No ❑ TO to NO 11 . NAME AND ADDRESS OF CERRNBI IPNY=M, COIIOMP S PHYMM OR OOUNTY ATTDIMIETI irwS aF np 20 7WEi NCI 21, MEMDDppppflnW 2To DATF 21d diC1E1aATORY /03 ® ❑ R Ma 19, ZgOq tl awn Mason ai P ter 22A Vurmopm NDIAE . NAIAE I VO CEME► OR CREMATORY LOCATION CYty OR TCON/ TmW Kleine Funeral Home ❑ ❑ ^I Grand Island, Naxaaka 226. FUNERAL HOME ADDRESS WFICET OR .D. NO, CITY WrOft. STAY[ 211 3213 W. North FXgnt St.,_ Grand Island Kaska 68803 -- - 29. OM1EWTE CAUSE WFERONLY OW CAUSE PER LM FM IAI. IN, AND Ich ' AyPvrAAaANAKwAaAI A4ipM PAW (*-Respiratory Arrest _ Minutes UlR fucAT KSACLAYlStWCKlx ur . P�rN PaRlNrl wNwaPNaalaw Stroke 2 Months DUE TD. OR AS A CONBI?OUENCE OF AArW Aw.wl irM aw d+Yh IEI PRRi -Cw4we cwoew mole dam m ftmil p PA r s 004". WAS TNEREA 24 AUTOP6v PREGNANCY N/ THE PAST ] MONTHf+ N 47 wAftASE TO MEVIDAI E%AANNER OR CORpNE+K' (04" 10-N YLL ,b Yw MCI Y- No 2fa 2!e DAYS OF W,M1RY I- OAc Y >J 2k, HDI1R of NLNIRV M DESCFW NOW NWIIRY OCCUWD ❑ wxawt UAtlaMA.Aad SpcAa PMiMq M i i. 1110WATWOM 2f1 PLACC OP MIIIIIIY- i1 .yPn. ,IrN1.lk(pY Ng LOCAT'IA $0110h R.FD.ND CITY OR TOWN $TATE ❑ Hom.cea+agA�^ y" E] No . 27a DATE OF DEATH also CW. Yr) 2Ata DATE SKMD Ab. Day n M TIME Or DEATH S May 15, 2000 Y Y 27e DATE S*NED rW Ow » r 2. c TIDE OF DEATH 2fc PIgN01NICE0 DEAD /M1 aY. W! ». PROMOIMICio DEAD ,Mkwr P270 May 16, 2000 3:20 P. M�� : M To NVdawar"Y ,dAMAMplem&Wdwto2M olwlreMYpnwnacaa/w• eAum 1maw. ft Mm dW AM pYa AM dw 11 M Mm"I 000 rtlT Tft 29 DID TOBACCO USE CONTMiTE TO TmF ftww sOe IIAB TISSUE DONATION lEEN CONNIDERED•r Xb WAS C011m. ORAICTS01 ❑ YEs ® No " ❑ wo om ❑ YEs 92 No ❑ TO to NO 11 . NAME AND ADDRESS OF CERRNBI IPNY=M, COIIOMP S PHYMM OR OOUNTY ATTDIMIETI irwS aF np I