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<br />sTAT¢ ~ I~onASiu-a~A11TrEI1T 0~ NEALt11
<br />nnlEAU a v/TAl STATISTICS $1. ~} ~ 2 3 6 ~
<br />CERTIFICATE DF DEATH r • ,
<br />E A A rMe. Der. [..,
<br />___._--e.~ -
<br />M -NAME 1
<br />Robert April 13 1981
<br />Merton Carpent_e* j, male E
<br />1
<br />RA -iet-•riM:N,ttsf[. ANI~fM ORaf'siN,Ol SLENT(t R-.Im{:w,Fft.wen, AGf-ten t~nF~.~VNOF~ NDEt1~Nf OATEd RIRTN rAy.Dy.fr.)
<br />~...k,J,~,y)~ Mos. oAfs ~ Noun; September 16, 1922
<br />,.e»n..b,rs,..~~ite unknown ~{ 4 58 w. ~«. ~1
<br />NAM[d S?Ot/i[fN.Mt, 9:w ""~"""") _ !E
<br />• A A[Of SIKH( AM in U_S w, C,R[ENd WNAi COUfHR[MA tD,N MARK O.
<br />DrsP.fur, Marcella M. Riley
<br />"'"'~~u°e' Springs, Nebraska, U.S.A. `o~marr°ie~1cF „
<br />f - RINOd NSINESSdINDUfTMf COUNTtd D[ATN
<br />SOC,A[SftV1119TNUM{ff ,uwA:~tvsAf~v•G;,,.;,,~+r..na..a..:~.a-..f I Hall _-
<br />la...F~ ,~ E..e..a, :.~ - --
<br />,E SSZ-28-973b ,,, ~as~'ce~room supervisor ~=i',~s Y.W.C.A. ,.,.
<br />MiS,O[ C,Tf IUANf NOSMTM d OTNN i,tfT,TUf1pN - Nar f1[ irof in t:1Mty, H NOY Df-W[i-,nQi,eR DOh
<br />c,n. Town of focA*la+d DEATN D,ye„w,t~.. ~,, wf'«'rs..:•r,
<br />jff,.,:f,E.,..N., t... inpatient
<br />Grand Island ,,., yes ~,.~ ""'(~ o~s¢ital .N.
<br />} - fTt[ET AND NUMREt Nf31Dl ClT'E[MUfl "
<br />REHDENC[-SSATE ~C(NENA CST!'. TOYYN dIOCATION (f y.,M Ny)
<br />Hall ,k Grand Island S23 West 17th 5;. ,s,. Yerj'_
<br />,f.;Vebraska ,s, ~1sa
<br />---- VSO-'~~ N -MA1 NM ! E
<br />A r W
<br />Johnston Carpenter :, (dec.) Emily Jane Dyex
<br />, (dec.) Bo Swell va~way~. naMe ~~yotTawN.aun.:,n
<br />wA1 OELEASFO Et'Ff ,N US AWED FOtCEfr {INEOWANT-NAME-1[4TeONSHlr-HARING AODRfn823 Tte~L Sf Lte ~,~y-
<br />~ m a+~ r
<br />,fYes%WWTI~i~}-24-416-16'--A3 }hrs. Marcella Carpenter,wife,G~a~ Islaz[~~NE~ 68 yTAEE
<br />`GFMEt[ff Of CtEMATOtf -NAME
<br />ril 1~, i°81 1~ Lincoln 3lemorial Cresnator}Evoe Lincoln Nebraska
<br />mation ~~4~' 68801
<br />-4 f[ A [KFNSF f10 fUNttAI NOME -- NAME iND AOD.tfSS !SitRtT d 1 f 0 ND. C~fr fM I,TMN, f1Ai[. EIN
<br />`~~~~"} '„Apfe1-~P~utlcr-Geddes 1123 W. 2nd, Grand Island NE.
<br />---'. Al - NE fNe-Der. r.1 ~ E TN
<br />i F7Ait d DEAL ~ trt f•, ~~+ -
<br />°^~' ~ SAO 174- M _
<br />ril,f i. i48i 'i.P ;rfoNOUNtfoofwotNe...,
<br />2L tlONOVKK EO DEAD
<br />N (Me Oer. r• 1 NOUt O[ATN
<br />E~ jI C 8 _ rMn De., r..,
<br />i iri April 14 , S 1 t>< ,?~.. ~ "` - ?? ,.. .. ...~. s....+
<br />. ed N .. W ; Q O, e~ • n...+.,v.wr.. ,. n .pre
<br />L • W Y... M irN.1n ((~~ - y d ~ M rNr. wI Aw ~ Mn .a.~ftl /Mt
<br />{ ,..n.,....e rr~r~T.lJ~ ~~ C~. ~~~~~f! ~ !~ i fie s. ,t r-
<br />i 17d rs,E.......
<br />NAME A~yp" ,~' pf[S~QrCEETIftEt S1Nr'S,CIAM, C4tONEtS ENYfsC UN Ot CQS,Nt AttOeliEn . t,pe a. r. ,
<br />S. R. Rathbun, M.O.L~'A Ho~ital~ 2~~1 tiortl~BroadwellD~TE Ec[nyD~T~ECasruirwED...68801
<br />Id fYE~^, ,wrwl .M~w .nw sM M.M
<br />7,r^-~ ~wM--~S4~ f ~; ((Nf[f ONtT CNf CAUSF Eff rrN[ f0t te,• !tr). ANO f,{'
<br />• r.er Zd coins.
<br />j PulmonaTr~ emholism ---------°-----_ -~ t„M,,,.,~,.,,,,,,.w.,,,,,
<br />r
<br />- A A toN OUENG[ d
<br />I unknown
<br />IN Deep venous thrombosi_ - --------- ~..,~:,.~....,„,,,....,,.
<br />DuE ro ar As A GoNStou[NCF of
<br />4 coons.
<br />,~ (,eft hemiplegia .~ ...~.r. __,__.~ -;,~. w ., scAM NfEfND fo Me`aGAS-'
<br />..., ~ . ,
<br />DMO:i#Y+i-C.W~r .a,.yr^^f ~• Mw. F. w.3 MfN a nRM r '.-Et4MtMtf +b COIDNEt
<br />ruT AN fa.:.x: ~w .Hf ..s, s.o«,ns. i ~ : s...+, ...
<br />n ~ w.
<br />" .'~SHO .« :: N.: names 'tf no
<br />.~_._. -_~. _.-_.,..._'b,XblE v0'. fwtiff Q UYfO -
<br />ACC,pN,, SUK,DE +O/eCW,. ~Meq, ~ pAlt O! wfUtf pr. ^+.r .. nCtif p wo_'N
<br />Dt rfNNbG ilMxt.WSgN fi.,r•gi '
<br />_ _x~-d-- ftfs q ,W/N SSAtt
<br />~~ %fiaCt ~Nt! _ ari. (~~.~w.--fw ~.. ~ ---•.IX.~KJM -._.-.- 1eMf, O! f f 0 W
<br />llyYlr A~rQ~ v
<br />~ 15fw,i, f . . .n,.. .. is.f ,z,«,.r
<br />~ X1! --.. .. _ __
<br />` SDf. -
<br />WHEN '1',8,8 COF;' CARRIES TAE RAISED SEAL OF THE NEBRASKA
<br />STATE I)$PARTME!V'~.;OF HEALTH, IT CERTIFIE5 THE AROSE TO BE
<br />A TRl1E COPY OF A14 ORZGZNAL RECORD ON FILE WITH THE STATE
<br />DEPAR.~3~~1T OF BEAI.~TH, BllREAU OF GZTAL STATZSTICS, WHICH
<br />IS TH$K.I:F,GAL DFF6~ITORY FOR L'ITAL RECORDS.
<br />DIRECTOR OF SITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA ?sued ;ipril 20, 1981
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