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<br />WHEN THIS COPY CARRIES THE RAI~tED SEAL OF THE NEBRASKA HEALTH AND N.UMAN SERVICES
<br />SYS~M, ITCERTIFlES THE BELOW TO BE A TRUE Cf~PY OF`THE ORICalNAL ~L9R1~QIiI~ILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISF%C$.$E~tl~l~ - .
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS -
<br />DA TE OF ISSUANCE • N
<br />r~ov s zoal 2 o i o o s s 41 _- ~== 4_. Wis. ~Q
<br />A~3/~iANT S7'ATERI~I~TRAI4
<br />LINCOLN, NEBRASKA HEALTH ANl3~`(~UNi,~I N,4E°RVICES SYSST,EM
<br />STATE OFTIE9RASKA- DEPAR7MEIV'C bF FQ;ALTH AND HUM~1Q SERYiC~x FINA3IEE-AND,~UPPbRT
<br />V[1'ALSTATISTICS _- O
<br />CERTIFICATE OF DEATH - - -.-.
<br />
<br />1~2Q9
<br />I ~ DECEDENT -NAME FIRST ~ MIUDI F LAST Z. SE~C-~~-'. ~• -~ 3 DATE OF DEATH (Mwrlh. D;IV. Vearl
<br />Lloyd L- Finnigsmier Male October 19, 2001
<br />4 CITY qND STATE OF F31HT'H 111 no+rn USA.. name country) Sa. AGE ~ Last Blnhtlay UNDER t YEAR UNDER t pAV 6. DATE OF BIRTH /MPn/h. Oay Yead
<br />Kenesaw, Nebraska IYry' ~~ $6 Mo's. I Dgvs 6~.Houas MINs March 26, 1924
<br />7 SOCIAL SECURTIV NUMF3EH ~~~ 6a PL.ACF OF DEATH
<br />507-20"1101 HOSPITAL'. ^ In patient OTHER' ^ Nursing Horne
<br />8b. FACILITY -Name
<br />lll not rn57ifUlrpn, give 5/leaf and number) ^ ER Outpatient © Resitlence
<br />~+
<br />Home: 952 S. Oak ^ DOA ^ Other /SPeCrlyl
<br />6c CITY TOWN OR LOCATION OF DEATH 9d INSIUE CITY LIMITS Be. COVNT'V OF DEATH
<br />Grand Island Yes ® Np ^ Hall
<br />
<br />9a_ rTESIDENCE: STATE ....~ 9b. COUNTY
<br />9c CITY. TOWNOR LOCATION ~.~_ _
<br />9tl STREET AND NUMBER llncrurnng Zip L'alel 9e INSIDE CITY I IMITS
<br />Nebraska Hall Grand Island N
<br />^
<br />952 S
<br />Oak 68$01 1 Y
<br /> o
<br />.
<br />es
<br />_~
<br />10 RACE ~ leg, White. Black. American Indian, t t. ANCESTRY le g uauan. Mexican, German. eicl 12. ~ MARRIED ^ WIDOWED t3 NAME OF SPOUSE (n wde prve maiden name/
<br />eICIISnFCIryI (Specl
<br />Whyte ty) NEVER
<br />American ~ DIVORCED Adams
<br />Bonn~.e
<br /> _..._.........,~._. _ Mme,.
<br />~
<br />14a USUAL OCCUPATION lGrve kind o! work done during mast 14h KINU OF BUSINE Sti IN Ul1S (RY Cpnlp191etl,
<br />15 EDUCATION
<br />Speclty Unly nlghest g+ade
<br />I
<br />of working hie. even r/renredl
<br />Auto Technician I
<br />~.L Automobile _
<br />_
<br />Elementary pr $akorwary lo~t21 College ll ~a or 5.1
<br />11L
<br />In r„I„tn-r.,,Mr rrr„I Mruu~r ~~~r , M„,.,~r, rrn~l Mr~~« m„r~~~~~,,.,~.„mom
<br />= John Finnigsmier Katie Stechewek
<br />18 V/A5 uECEA$ED EVER IN U.S. ARMED FORCES? t9a INFORMANT .NAME
<br />es. np ~r ~n . ~slgwe w3 a 4 a .l 9 4~3e
<br />Yes:
<br />52/10/1946 ~ Bonnie Finnigsmier
<br />i 196 INFORMANT MAILING ADURESS ISfREET OR R,F U NO. CITY OR TOWN STATE, ZIPI
<br />...952 S. Oaks - Grand- -Island; -1+FE:. - $8$0~ - - . _ _ . ,.. _
<br />EMB MCR -SIGNATURE & LICENSE NO. O ~ C 21 a. ME THpD pP DI$Pp$IiION Ztb. DATE 21 c. CEMETERY OH CREMAIORV NAME
<br />~~, ".~, /z! / ^ Burial ^ Remnvxl Oct. 23r 2001 Westlawn Memoriag~a°~Cy
<br />22a FUNERAL ME -NAM 21d CEMETERY OR CREMATORY LOCATION CITY OR TOWN STATE
<br />Apfel--Butler-Geddes ®crema°°" ^ D°nal°„
<br />22D FUNERAL HOME ADDRESS (STREET OR R.F.U. NO.. CYIV OR TOWN. STgTE, ZIPI
<br />1123 West Second, Grand Island, NE. 68801
<br />_ 23.~ IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR la,. Ibl, ANp (cll
<br />PART
<br />_ ',a, Natural causes
<br />_..
<br />- DUE TO, OR AS A CONSEQUENCE OF
<br />161
<br />DUE TO. OR AS A CONSEQUENCE OF
<br />Icl
<br />I Inerval between onset and deals
<br />Imerval between onset and deals
<br />OTHER SIGNIFICANT CONDITIONS - Contli6ons contnbWing to the tleath out not relatetl PART III IF FEMALE, WAS THERE A ~ 24 AUTOPSY 25. WAS CASE REFERRED TO MEDICAL
<br />PART
<br />II PREGNANCY IN THE PAST 3 MONTHS? EXAMINER OR CORONER
<br /> IAgeS 10-$<) Ves ^ Ny ^ Va5 ^ NU ® Ves ~ No
<br />26a 266. DATE OF INJURY /Mo.. Day. Yr.J 26c HOUR OF INJURY 28tl ~ DESCRI6E HOW INJURY OCCURRED
<br />Accident ~ Undetermined
<br /> M
<br />Surcrda ~ Pending 28e. INJURY AT WORK 26f. PLACE OF INJURY - At home, larm. 5veet. laCtory 26g. LOCATION STREET OR R F,p. NO. CITY UR YOWN S(AT'L
<br />
<br />Homicide Investigation ^ ^
<br />y
<br />N oN;ce building. etc !$pacityJ
<br /> es
<br />o
<br />27a pATF OF pEATH /MP.. Oay. Yr/ 28a. UATE SIGNED /Mp.. Day. Yr.l 28b TIME OF DEATH £ oun d
<br />'
<br />Y ru~~~--v~ 1:30 nm M
<br />-
<br />~
<br />~
<br />. ~
<br />- -
<br />N
<br />276 DATE SIGNED /MP.. Oay. Yr.J 27c. TIME OF DEATH
<br />I ~ ~ c ~ Bc. PRONOUNCED DEA IMO.. Oay. Yr.l 28d. PRONOUNCED pEAp /HPUrI
<br />~~ ~¢ ~ ~
<br />
<br />M October 19 200 1 4 nm M
<br />$ F $ ~
<br />,4 ~ 2Ytl. To the best of my knowledge. death occurced al the ame, tlate and glace and due to the ~ ~ 28e. On the basis of examination and~vr investigation, m my opmipn deals occurred
<br /> a~.
<br />causels, Stated. ° ~ the time, date and place ann nuc r~ •~° --~- ' '
<br />~) > ~>ty~...., r ~
<br />~
<br />'
<br />0
<br />ISr9nature aria Title) - L~ V
<br />r ~ ~ r
<br />(Signature and Titlel -
<br />Z
<br />' 29. DID TOBACCO USE CONTRIBUTE TO THE DEATH? 30.a HAS ORGAN OR TISSUE _
<br />DONATION BEEN CDNSIDERED~ 30.b WA5 CONSENT GRANTED'+
<br />^ VES ^ NO 1 UNKNOWN ^ YES ~ NO ^ YES ® NO
<br />31 NAME AND ApDRE55 OF CERTIFIER (PHYSICIAN. CORONERS PHYSICIAN OR COUNTY ATTORNEY( ; rypa w Pr,nrJ .._.•.__~~~.. ~_
<br />S t D Vitera G1PD 131 S Locust Grand Island N~ 68801
<br />32a REGISTRAR W 32b. DATE FILED BV REGISTRAR /Mp. Oay Yr./
<br /> ~IOV 2 2001
<br />Interval between pnspl and dells
<br />unknown
<br />Grand Island, Nebraska
<br />U- ~ ~-~
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