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<br /> <br /> w <br /> a, <br /> 1 A MIKA <br /> 7. <br /> 1 ~ q tip ~ ~ ~ + t (r <br /> 201001848 <br /> MISSOULA COUNTY = <br /> <br /> CERTIFICATION OF A DEATH CERTIFICATE <br /> FILE 200932-Q04793 <br /> FULL NAME, OF DECEASED: Gary Lee "8chuet:t SEX: Male <br /> DATE OF DEATH: July 22, 20Q9 PLACE OF DEATH: M15,50V14. <br /> <br /> RACE: White <br /> DATE OF BIRTH: January 27, 1938 BIRTHPLACE: Wgad River Nebraska <br /> MOTHER'S NAME: Lulcil.ea;,Baird <br /> FATHER'S NAME: Allen' Schuett <br /> MARITAL STATUS: Married <br /> SPOUSE: Devonne Sohuet:t' <br /> SOCIAL SECURITY NUMBER'. ' 506-40- 545 VETERAN OF ARMED FORCES: Yea <br /> RESIDENCE: Grand. ;aI§$nd', .':Nebraska <br /> FUNERAL FACILITY: Gardef~"(7_.ty .Funeral Home ; <br /> <br /> PLACE OF DISPOSITION: Cvr4nd ;q;and',City Cemetery <br /> ~Grand_Tal.aad, Nebraska <br /> METHOD OF DISPOSITION: Removal <br /> MANNER OF DEATH: Na.tu.ral " DATE"F4LEp: July 29 2009 <br /> CAUSE OF DEATH: <br /> ONSET: <br /> a. Anoxic braid injury` * 5 clays <br /> _b. Ventricular fibril]at igrx arreetr 5 ddys <br /> c. Non specific cardiac dt s:ease= Y: '^`r,,: p <br /> OTHER SIGNIFICANT CONDITIONS, <br /> HTN <br /> NAME AND ADDRESS OF CERTIFIER: 1 <br /> Richard Sellman , 601 SPI~VCE ST-1 Kisanul~k 59802 <br /> DATE ISSUED: July 4,7, ZQ0.9 BY: <br /> L . <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 1 J, Thi9 certifo that, this document is a•true replication VICKIE M• ZEIER w a <br /> ff~~ 238049 ~f the prlglnal linkrmation on file with the Department - <br /> _nf Public Health and Human Servicss. Clerk and Recorder 9+ <br /> Not Valid Unle&e Raised Seal is Present <br /> r q4: <br /> el, <br />