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<br />STATE OF NE~RASRA-DEiARTAAENT Of HEALTH o
<br />lUREAU OF YITAt STATISTICS f~ ~ ---~~ ~ ~ '~ ~ ~)
<br />CERTIFICATE OF DEATH ~.. ~,; {~,
<br />E N -NAM fIR Mt lE U SER DAI' OF DEATH (Me., Dey, Tr.)
<br />I George Harm -?ihBF Quadhamer x male 2 April 30, 1981
<br />RA E-(.. q.- W~osL, Mw..k°n OMGIN(OEiCENT(.. q., N°Iian. Mewi.°n, ~ AGE-i... Nwxdw( UNDER 1 YEAR UNOfR I DAY DATE OF EIRTN (MO., Dey, Yr.!
<br />~ Indien, ek J( ) Wrine^, eK.)(SO fF! ~(Y».) M03 ~ DAYS NOUI$. MINS
<br />w~ii~e 1 unknown r r ~, 71 Da ~~ TAprii 12, 1910
<br />I AND STAT! Of RIRTN (H ^el in V.S.A., CITIZEN OF WHAT CO NTRF MARRIED, N[VER MAtR1ED. NAME Oi SfOUSE (If mile, give hoiden ne»e)
<br />~ w, a / WIDOWED DIVORC (Spn[+fF!
<br />1 ~»°F~ildreth, Nebraska F U.S.A. In married II, Jean Faye Adams
<br />SOCIAL SECVdTY NUMt[R USUAL OCCUTATION {Give kind o(~oH denF d..iwy nws KIND Of RUSINES3 OR INDUSTRY COUNTY Of DFATN
<br />510-26-4234 °f°°"k'"La`6orei "~°d' "a`t3 ~ General Hall
<br />12. 12e. S 126. Id°
<br />CIP(', TOWN OR SOCATION d DEATH INSIDf CITT LIMIFS NOSfITAI OR OTNFR INSTiTUT10N- Ne~ne (If not in N,Ae., ~ e ,q5e OF rNST tes'vM. DOA
<br />(SpesilF Yes or Noj give „»N ° ( ; Orry».~e»IF.e. 4., tn,ewe+r (SperAy!
<br />Grand Island es 1~11""1~'os ital inpatient
<br />u . 4.~ Y Ide P Ile.
<br />RESIDENCE-STATE COUNFY ~CIT', TOWN OR L[KATION STREET AND NUMDFR jiNSIOE CITY IIMliS
<br />73e.Nebraska ,Sb, Hall ~,x Grand Island '„d 1511 West 4th i'S~SY~~•'O•N°,
<br />A R-NAM f MIDpIE U i .~AW NEE-MAIDEN NAME frRST MIDDL UST
<br />~ (dec.) _ John Quadhamer ~ IT I•i? nni e ~
<br />s ~-
<br />~n WAS DECEASED EVEI IN U 1. ARMED iOKES1 ~ INfGRMANT-NAME-Rf IATIONSNIF-IMIIING ADDRESS ISttffl d. T CF tOWN, Si1iE. I~(1
<br />688Hf'
<br />,RYes)~~~J~~-18-4~~~'=~~-45 'y~x-s.Jean Quadhamer,wife,1511 W.4th,Grand Island,NE
<br />6URIAI, Ge.+e"en. R•~no.el DAF ~CEMETFtI OR CREA4TORT-NAME 'i LOCATION CITY OR TOWN STATE
<br />xo..~~1a1. ~2obi~}T 4E 19g1 ;xo( Ft. *icPherson Nat'1_ Cemetei~d i+Iexxell NE
<br />' -SIGNATVRE i [ILfIVSf ~ FUNERAL NOME - NAME AND ADDEESS IStFF(t OFF , D NY_UTY DF iMN STAth ILO
<br />„ , ~~t~ ~t ;1, Livingston-Sondermann Funeral home. 505 W. Koenig,l
<br />DATE OF EATM (Ma.. DeI. (• 1 : _t- 'DATE SIGNED (MO D°,, Y.) ~, NOUE OE DEATH
<br />~x>a. April 30, 1981 '=Q ": 2.e ':Ab M
<br />IdA~RriN (Me., DeT. Y..) NOVR ATN ivy ;FRONOUNCED DEAD !: EtONOUNCED DEADINOVIJ
<br />;Erd~x26. ~4a 4, 198 !x2F. 4:r M P}=p;(Ab.~°(. Y.,
<br />X24 2.d M
<br />f ~ i i• .M M/ el .( LwwAedta d.dM e/ Me ,~ . 0.. ~ ,Me s Q ~~ ~ D. b yee~ ., e.rwenw eMM -+.np ~. • . n».. 0.eM ~.ened el
<br /><eu.R.) need- T hti ^., dare e.d vta.. °.d dw w W .n. °~ .»»! ~•
<br />e0 6
<br />,z~,we«..r T:W)~' _L~ L l !xa. IS.F,°.n».w r. .,-
<br />NAME AND ADDFF S Of C tTlf K E AN OF Fh (Type er P"»„
<br />al h L. Blair h1.D. VA }ios ital ZZOi ~;orth B adwell, Grand Island, NE 68801
<br />REGISTbt _ - ,~ 'DATE RECEIYED EY tEGISTtAR (Me, Doy. (. )
<br />~!/% L/
<br />IMMfpA CAVSE (EHIFt OMIY ONE CAUSE .FR tlNf FOt (o!, rbi. AND f.lt .r~.e, enw.n amw .., NeM
<br />fAff
<br />;., Carcinoma~of the tongue with probable cerebral metastases 2 yrs
<br />. OE AS A CONSEOVfMCE Oi: ~rw_1 Se..e.w enrM ew d«M
<br />Mi
<br />Ol/ TO, OF AS k CONSFOV[MCE OFD ~-.....1 sw...n «.« end deeM -
<br />ld.
<br />FAtT C t-cw4Mx.rnW+.. » d«M e.+....n.»d : ,Ai( fn M IDUIt wA3 TNIFE • ~ AUTOeST ww3 G%Se F!(EFFFD TO MEgUI
<br />~ !F[tONANCTIN iNF (ASi]MONMS( ;t3°Ndf Tw ., Ne. ~(%AWNfF OI COFONEt
<br />ItSerd, (« er w,
<br />~, N. ^ 2t no jx4 no
<br />K . SUK.DF, NOr,S.RF. [MN OF uuuF( (re. Der. *. , -, ^OW a .wa,n ; DEXht! nOw +(uUte OftuFFfO s
<br />OE!lNOING rtlvf]tgwTgN (leri, ~,
<br />]Oa t 7Db. ~~ SO( M ; 30d.
<br />t UR(r teptF .NlutT-.. w...., t.,~ .,.w ...w, ""`~"~"TloeAiloN StnEF o.~ F. D w clFr pR itw.N 1(A(E
<br />Iiree+r rw«w., ;.xrgb.ui.v. s.ls°«ry
<br />]0., f___., ~~,,.. __ Ste'-_____.. _.
<br />cLRN THIS COPY<CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />'STATE DEPARTi4f;2iT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />frA TRUE COPY ~F AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />..tom ~ARTMENT• O~Fe HEALTH, BUREAU OF L'TTAL STATISTICS ( WHICH
<br />.F,~=$1!il$.=LF~G'$Y. IYEPOSZTORY FOR LTITAL RECORDS.
<br />~ ~ a~
<br />DIRECTOR OF VITAL STATISTICS Ah9 ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA issued ?7tay 22, 1981
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