Laserfiche WebLink
9NHEN THtS COPY CARR/ES THERA/SED SEAL OF THE NEBRASKA STA7E�EPA�Ff�E�EALT1� <br />, l7 C�ERf°1F/ES THE BELOW TO 8EA TRUE COPY OF AN OR/G/NAL RECpRD O�f/E��M�l�"� <br />DEPARTMENT OF HEALTH, BUREAU OF VR.AL STAT/ST/CS, WH/Ctl /S TH�Ait �'P-QSIT.�RIJF�R <br />V/TAL RECOROS. `= -_ _ <br />DATE OF ISSUANCE t� _ � <br />_ � -����'' _ <br />� FE� �i995 2011p��4� -:- -�- �# -_ <br />' STA�£� � �QPL'R. I#TREC�� <br />UNCOLN . NEBRASK.4 EUREA(!'��/lt��S�%�T�3 . _ <br />_ __ -- - --__ _ _ _ �..- - <br />STATE OF NEBRASKA - OEPARTMENT OF HE7t�'E#� � =�` _ <br />BUREAU OF VlTAL STATiSTICS � <br />• � CERTIFICATE OF DEATH <br />t. oECen� . wawe FwsT �noo� uasT z s�c 3 OATE OF OEATH in�m. �< rea.� <br />Harry A. Rinder Male January 22, 1995 <br />�. 4. CRY AND STATE QF BIRTH m�arn us.a. � w�rmy� 5e. AGE - LaslBiMday UNDFA 1 VEAR UN�ER t DAY . 6. DATE OF 81RTH /Ma�Xh Dey. Year/ <br />NOI'fOlk, Nebraska r'�� 74 5°. "+c's � oars s�.++ouAS� M�NS JUly 22� 1920 <br />7. SOCIAL SECUATY NUMBER � � Ba. PLACE � DEATH � <br />506-09-3449 HosPrra� [� m�n on+ea: [� H� � <br />�. FACILITY - NetnB lbtrot v�SO'Otfaon, gitre �eB7 a� numhier) � 1 � Efi Ou�ertertt � ReS�CBnce <br />� <br />St. Francis Skilled Nursing Unit ❑°O" ❑°����� <br />8e CITY. TOWN OR LOCATION OF pEATH 8C INSIQE CITV LIMITS 8e CAUNTY OF DEATH . ' <br />Grar�d Island Y� XD �❑ Hall County <br />9a RESIDENCE - STATE Bb. CAUNTY 9c. CRY. TOWN OR IOCATION ' 9tl SiREET AND NUMBER (Urciu6ryZip CodeJ 9e INSIDE CIiY LIMITS <br />Nebraska Hall Grand Island 1822 W. Anna St. , 68803 Y� �C] No ❑ <br />t0. RACE - lag. Whae. 81ack. Amenean Indian. � 1 t. ANCESTRY le.g.. dal�. Mewcen, Gertnsn, �t1 12. � FMRRIE� ❑ WIDOWED 13 NAME OF SPWSE (n wrte. grve meMen name) <br />����� White � American �� "A�' DNOACED Virqinia Hay <br />� 74e. USUALOCCUPATION /GrreMMa/a�kdaveCUrbaBmost /4b. KIMD � �41 15. EDUCATION ISPetMoniYh�gl�eaf9��eomWetetl) <br />dw�rghTe.even�myay� LciW r <br />Attorney ��� Mayer, Burns & Ahlschwede �"' � �ry10-tZ, �°+� ��-0 � 5.� <br />16. FATHFA • NAME .� FlRST MIODLE lA$T t 7 MOTHER � FlAST MIDDLE MAIDEN SURNAME - <br />Harr�r A. Rinder (Dec.} Helen L. Larsen (Dec.) <br />1fl WAS DEOFASED EVER IN U.S. ARMED F6RCES7 � 18a WFOAAAANT . NAME � . <br />m � Yes � �� � � � <br />�W�I �-�=�0 3-5-43 Virginia Rinder <br />19D. INFORMAN7 � MANNQ ADORESS I5TREET 01i RF.D.' N0. GTY �i 70WN. S7ATE ZIPJ � . <br />1822 W. Anna St., Grand Island, Nebraska 68803 <br />20, - NATU LICENSE NO. 21 a METH00OF WSPpSITiON 27b. DATE � 27c. CEME7ERV OR CREMATORY - N0.ME <br />�.°��� '� ��3 �� �,�,,,,� Jan 25, 1995 Grand Island City Cemetery <br />22a FUNERAL NpME - NAME � � � 21d. CEMETERY OR CREMATORY LOCA7lON CRY OR TOWN STATE <br />Kleine Wiest Funeral Home ❑�°^ ❑°on�°^ Grand Is].and, Nebraska <br />.. 22D. FUNERAL HOFdE AD�iESS (STREET OR R.F.D. NO.. CITY QA 70WN. STATE. ZIP� . <br />. 3213 W. North Front St., Grand Island, Nebraska 68803 <br />. IMMEDUI7E CAUS f - � 1ENTER ONLY ONE CAUSE PER 11NE FOR fa�. lb�. AND (c�� . � � �� IMerva1 be�ween M581 ar�tl tleath <br />� <br />� I <br />(el I <br />DUE TO. QR A CANSEDUENCE . � - � u�mrva� benmen a�set ana deaa+ <br />i <br />@1 1 <br />DUE TO.OA AS A l�HJSEQUENGE 0�: � . � tManal omween ottsei a�y Aeam <br />� <br />I <br />��) � <br />P � OTHER SIONIFICANT CONDRIONS - C:a#tiais tmtr�b�'ng ro Ihe dealh but mt related PART UI tF FEMALE. WAS THERE A AUTOPSV . WAS CASE REFERRED TO MEpICAL <br />- � PREGNANCV IN THE PAS7 3 MONTHS? � EXAMYNER OR CAppNER'+ <br />p <br />(Agas�o-sal Yes No Yes Ho Ves No <br />28e. � 2�. OATE OF INJUqY � /MO-. Day, YiJ 28c. - HOUR OF IN.NRY - 28d. DESCAIBE HQW IWURY OCGURRED <br />� AcoiGert � UMetettmfretl � M <br />� SuiCitlB � P8r�n9 288. INJURY AT WORK Z6t. PL0.CE OF NJ� ( hAi meo . lertn. street. faclnY 269. LOCATION STREEf QR R.F U. NO. � C1TV OA TOWN STAiE <br />offxe buutluf& SP�Yt � <br />� Momkitla tnve�mwn Yes � No � . <br />DATE OF OEATH �Mo- DeY� y�•I 2Ba DATE SIGNED lMO. Oay Yr t 2Bb TIME Oi DEATM <br />� <br />�'3 �/ Z '� S � �"c AI <br />u . OATE l�.. �Y. Yci 71ME OF pFATH ��� y 28c PRONOUNCED DEAD /Mo. Oay, Yr! 28tl. PRONQUNCED DEAD /HOUq <br />� ' 6 <br />F ��3 ��' S:OI P.III.M y � M <br />8 � <br />tl. To tlie d my . tle _. al Ihe aM mW 6ve to Rie �� 2Be On Ne Casm af exammatron aM-a a�esogenw�, m my opnron tleath xuere0 m <br />ea�rsel �. � � � Ihe ama. Cace aM plaee a'a �e ro the causa4sl st�A. <br />ena rms� ene trne <br />,Q,. ao roeaccos �� E� uwc�nv �ns o�w oa �� �� ca+s�o�v� wns �ww S o� � No <br />� ��,I <br />�y 4Y <br />