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STXTf OF NE®RASKA-DEPARTMENT OF NEALTH
<br />„~. i b ~) ~ j ~ ~ 6UREAU DF YITAL STATISTICS
<br />CERTIFICATE DF DEATH~_~,; y
<br />DFCEOENi-7f wMF- EIRST MIGDIE -~f ~X ~-DATE OE DEATN IMO.. Doy. Yr.)
<br />Darlene Donna Arnall z_Female ~Decem1480
<br />i' AGE -le.r einndei UNDER 1 YEAR UN[)ER 1 DAY DATE OF @IRTN fMO.. Doy, Y<.)
<br />RACE-(e q-. WkHO. @locE, An«ken GRIGIN/DESCENT(1 p,lleiian, Mi.i-~----_
<br />Indion, ek )($pefily} Gernert, er<{f5pecifyl (Y..) MOS. ~ DAYS HOURS. MINS.
<br />White ~s,_. American i ' ep 49 eb. ~ ate. ~ ~7 March 31 _ 1431
<br />CITY AND STATE Of pIRTH (H nee ln)n V.3 4 CITIZEN OF WNAT COUNTRY MARRIED, NEVER MARRIED, NAME Oi SPOUSE (1l riles, piw Hoiden Ham)
<br />~ n~prtw ~epnxyl ' IWtDOWfD. DIVORCED(Spe<i!y) " _~
<br />~ p D8W$on count Neorasx 9. U.J.A. f0. LRarcieU II. Wi
<br />SOCtAt SECURITY NUMBER USUAL OCCUPA410N(Ciw Lind a/wrE done daring mole KIND O"+BUSINESS OR INUUSFRY COUNTY Of DEATN -
<br />I d wrSinq liti, own iF <erndi
<br />12. 505-40-7398 1>e. Housewife ~~' ub. Ide.
<br />CITY, TOWN OR IOCFTION OF DEATN INSIDE Citt tiMETS NOSPITAt OR OTHER INSiiTUTICNd-Nam /ll not ;n aklhe<, H HOSP. Dt tNST Iedirere DOA,
<br />1(Spe<ify YH o. Net qrW eheN and namberl OPyaYmneilme< b.. IngePwr (Spec j7
<br />,Ab. Grand Island __ ,.< Yes t.a. Lutheran Memorial Hospital nA.. Inp,Bt t
<br />RESIDENCE-STAY CETi OllNPOUNP' CItt, TOWN OR lCKA710N STREET AND NUM6ER INSIDE CITY UMEES
<br /> ~ tse.Nebraska !ub. Hall _ I& Grand Island ua 507 E. 19th Is..
<br />t6'ntn ^^^^< Jurgen mH. Aden ~ n EaRnB - Jobman
<br />WAS DECEASED EVER IN U.S. ARMED fORCEST INFORMANY-NAME--RELATIONSHIP-MAILING ADDRESS (STREET OR Rf.D. NO. CITY Ot TOWNYSj~E~7JP1
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<br />,q.William G. Arnall-Husband-507 E. 19th-Grand Island NE.
<br />@URIAI, Gemvlion. RenroroilDATE
<br />D EMETERY OR CREMAIORT-NAME IOCAiION CITY OR TOWN STATE
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<br />19
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<br />Burial ~zDb ,
<br />Iza. Gothenbui Cemeter z@d- Gothenburg. Nebraska
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<br />EMRAIM SlGNATURE~ IICENSf NO. y ~ ~ E ; fUNEtM HOME-NAME AND ADDRESS ,S}tEEI OR R f D. NO.. CITY OR TOwN. ST•lE. ZfPI
<br />z1 .% ~ !zmA Eel-Butler-Geddes 1123 W. 2nd Grand Island NE. 68801
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<br />, HOUt Of DEATH : i'r i , DA 1 NED IMO. DoY, Yr.) OU T6~ATyT-
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<br />~OATE Of DEATH (MO., Day, Y..)
<br />' iaQO iPRONOUNCED DEAD PRONOUNCED DEAD (Hour)
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<br />E AND ADDRESS Of CERTIFIER (PHYSICIAN CORONER'S PHYSICIAN OR COUNTY ATTORNEY) (1yPe o. Pnnrl
<br />NAM
<br />2D David Colon M.D. 729 N. Custer, Grand Island. NE. 68801
<br />REGISTRAR .. ~DATf f EIYED RY REGISTRAR (MO., Day, Tr.)
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<br />zea.rnRw~n,.,0~`~cLL"T~L"=LZ i~~r%~.L=6-~~i - /r%(!2~ j , ~ ~~ J~!
<br />27. If`-MMEDIATE CALrISE~f~ (ENTER ONLY E CAUSE PER LINE FOR lol, (61. ANO lc)1 nHr.e1 bww.~r aorx aM dwM
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<br />' />'~ F rA S 9-A?7 e_ (~.t,r t rnJp.vts) 06 ~/L£.IS s` ~ ~2 YEA S
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<br />DUE TO, OR AS A CONSEQUENCE OF: ~ m.,.ol berww °'1N' o=d dwM
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<br />PART ?HER SeGNI/KAHI CONDrl10N5-CeW itu« •onn•br~~np ro dwlM b,.. ..or .ia~ed •iI ~~i if fTAWi w 5 ?~fiE : i 3UTv<Si wy3 CASE lEffflfD t0 MEDrCAI
<br />II PlfGnANCr In inE yST l MONLNSi , lSp...ly r« o. Nel ~ fx•WHfR Of COEONEI
<br />_ . No(~ ~~ 18 f ~ ~ '.79. V
<br />•CC,DEMi. SU1C10E. HOWC!DE. uNDfr, D•EE Of iNLURY IMe.. Oor. < + ;HOUR p 1EUURYINIUii -~Tj OESCl1RE NOw INIUEy OCCUEEEO
<br />Ot EENpHG InYE3tIGAtNNf. (Sp«~fyl
<br />me. (_L.t1 [.$~ ~ 3D6. ~ so<. M '~~ 3L1d
<br />INLUrr •T won Acf a Iwwr- •. bone. la.m. .~. a >. -. foursoN SUEEI OR R 1 D Hp. utt o. towN surf
<br />LSpe<•!y r.r o• net -• ' olfw baifdinp. «< fipe<H,e
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<br />• ~S~1i.EN THLS COPY CARRIES THE RRISED SEAL OF THE NEBRASKA
<br />S'FXTE DEPA$Tkf,EP1T OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A=.~RUE COPX ~'F- AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />'~'~?P,RTM.ryNr~' Q`R"~HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />I,9,•T,H'E, LE~dI`~.;~EPOSITORY FOR VITAL RECORDS.
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<br />DIRECTOR OF VITAL STATISTICS AIQD ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA Issued December 22, 1980
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