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•`• ,• STA7E OF NEBRASKA-DEPAR7MENf OF fiFALTH AND 1IUMAN SFRVICES FWANC6 AND SUPPORT
<br /> Vf1'AL STATISTICS '
<br /> CERTIFICATE OF DEATH
<br /> 1.OECEDENt-NA F . .
<br /> M��E �T t.SEX �.OATE OF pEATH MIdM1 Ory�YNq �
<br /> , Virgil Phe�ps Knox Male Januar 21, 1998
<br /> s �.C �AI�STATE Oi&RTM l�nd/'i USA.�n�cpm�y/ �,AOE•lMl BN�� UNOEq 1 YEAp
<br /> UNOEH 1 OAV !.DATE OF lNiiM p{AprN!pq•,y�w/
<br /> Alda, Nebraska ry"�89 � � � �YS x.►�ouns wrs
<br /> �.soc�s��„rv,„,,,�q November 9, 1908
<br /> M.oU10E OF DEATM
<br /> . 712-os—s582 ►asa,K: � �,+ or�n p ww.i,q�,,,.
<br /> ee.r�c�rcr.►w,,. �r�or.w�,n a•�se..r.�d�wwwy ❑ ¢a oubwwr ❑
<br /> ��
<br /> . St. Francis Medical Center ❑ oo� � �,,�,y,
<br /> Ct.CIiY.TOWN pp IOCAiION OF py1TH !d.MSIpE dTY LMMTS � h.Cp(lNTy pF pEATI�
<br /> Grand Island YM � ►� ❑ Hall
<br /> Y� RES�DE►K:E•BTATE 9D Cd1NTV R.GTY.TOMM 011 IOCAf10N � /d.SiNEEt ANO NUAABER /Me .
<br /> Nebraska Hall "'°�"D�0�0°�'� a�+�a*ri�,xra
<br /> Grand Island 1317 N. Ruby 68803 r„� ,�❑
<br /> . �0.nACE•N.q..WI*e.B4cw.Mwe�n YiAbn. 11.ANCES?RV Nq..MWn.hNwkre Ow�nn.Nel Ip. MARq�ED
<br /> Ne.�ISoee�Yp (S��MI ❑MIIOOWED t�.NAME OF 9POUSE M�+h.pmrnuldinnrny
<br /> � White American NEVEp pVORCED Dolores Yocum
<br /> ty.VSUAIOCCUVATION /GIMAhOdwtrkA7rNAwipnpM 1�b.KMDOiBU91NESSM10U3THV
<br /> V dM81L1"`t nence t6.EDUCAiION � ' �boonqNMA
<br /> �` U.P. Railroad E ^�1'ae�co"d�ly b•t� ' CoMp�n.�as•i
<br /> C 16 FATMEp.NA61E F'/�gT �th Gra4e �
<br /> � . �E UST t7.MpT/1ER flpg� ANpaE AAAID�N�IMIIAI�
<br /> Wesle J� e`m�
<br /> o • ,� w�s oECUSEU�a�ua�o�oACes� KnoX EllB Mse Shi ton
<br /> C (�'M.ro.a u�kl Ir 1'��9�•7r�rd dN�d NrNC�p 1 W.MIFOIMIANT-N�ME
<br /> � No -------- Dolorea Knox
<br /> 1/p.RKONMNIT MAILMIO AOOpE� (STREET OR R.F.O NO.dTY di TOYVN.STATE.ZIP)
<br /> � 1317 N. Rub , Grand Island, Ne. ti8$03
<br /> V i0 E t R-SKi { !t�ME111ppdfpqpp�110N ltb.DAT!
<br /> z � � ' !1 / �L/�/ !IC CEMETERYORC�1EMAlOR� N
<br /> W E Zcy ' � �
<br /> ��r ❑�M Jan. 26,1998 Grand Island Cit Cemeter
<br /> � � � F�� N� !Id CEMETERYORCi1FMAtORYLOCAT10N
<br /> CIiYORfOWN STATE
<br /> twi s Livin ston-Sondermann F.H. ��"'"''°^ ❑�^�^ Grand Island, Nebraska
<br /> W �` YA.iUNEMI�ql'1�A�Of1Eg3 (STREET OR RF.D.NO..pTY Oq tOMIN.S7ATE.21P�
<br /> 0 t
<br /> o D 601 N. Webb Road, Grand Island, Ne. 68803-4050
<br /> 2�. MAAEpA1E CAUSE
<br /> W y VAqT IENTER pllY pyE CAVgE yER LNIE FOq I�I.IW.ANO kN
<br /> � � MwvN bMw��on�N�ntl O�Nh
<br /> Q o ' ,,, Cardio-res irator arrest �
<br /> Z LL. DUE TO.q1 AS A CONSEOUENCE Of� I
<br /> � MMrvM DN�Nn ornN�nd dsnh
<br /> � ro� Con estive heart failure. ;
<br /> oue ro.on�s�coNSEOUer�a �
<br /> � w��N e.�aaM.ro a.�n
<br /> Iq �
<br /> i
<br /> PAf1T�T�p���NT�ONaT1pN5•Cd�d�ory��q b IM W�F bul nd r�INed pARi pl IF FEMALE.WAS iHERE A 2� AUIOPSY '
<br /> � PREGNANCy IW THE PAST�MONiHgo �5�W�S CASE REFFpqED i0 MEOICAL
<br /> Chroinc obstructive ulmonar diseas i�9,o.�,, �„ ,� YM EXAMINERQqCpqp�p7
<br />� �° 2EA.DATE Of N1N1HY /Mb..aY•VI/ 2le.MOU11 OF MUURY � X YN Np
<br /> 4Bd.OESCRIBE FIOW MIJIMY OCCURREO
<br /> � AcciAenl � UMeMrmined
<br /> ❑ ar�na. � �...,,�t �.....�......,,.., M
<br /> � ❑ ���MC 1��"�"'�•+,•• MN IfY:�TM1M �t11FitMwilf Nff dTYdITOWN
<br /> o �� �,�n� ��, No OTATE
<br /> 4�� OAiE OF DEAtM /Mb psr rr� Y!a DATE SK3NE0 /Mu.Oar vrl T!b TIME pF pEATM
<br /> . a January 21, 1998 E��
<br /> �� Yle.DAtE 6pNED /11b.De�Yr) Y7e T OF pEATM 2!C PRONpUNCEO DEAD Mb. M
<br /> � � � I �Y•Yr/ tEO.PRONOUNCED DEAD Oburl
<br /> � Janua 1998 11:05 P.M. ����
<br /> E � M �
<br /> ' 2�0 io h Osp M M AsM�nd W�and due b MN a M
<br /> al�s 2M.On IM bsaN d s.nmmeMn�nd a InwMgeNOn.ln'^Y opNMO�deMh oceund M
<br /> � px 6me.Nb md plaes end dus b IM t�nnalfl NNM
<br /> M
<br /> ?8 010 tOBACCO USE BUT TO TME DEATM7 ud TiN
<br /> OO �p U�N� �D.�HAS OROAN pq iISSUE DONATION BEEN CONSIDEqEDi 30.b WAS CONSENT OW1N1E0+
<br /> vE3 � � YE9 � Np
<br /> � YE3 � yp
<br /> �I NAME ANO AppqE$,,pi�RiK1ER�PHVSICIAN,Cp/�pNER�$PHYS�CNN OR COUNTY AttOpNEYI lTrps a Prml/
<br /> William J. Lawton, M.D. , 2444 W. Faidley Ave. , Grand Island, Ne. 68803
<br /> 7Y� NEf313TMR
<br /> J�b.OAiE FILED BV qE01$TRAq (AAp.,p�y,Yr.J
<br /> FOR VITAL STATISTICS USE ONLY
<br /> Place.......................A................................B................................C................................D................................E................................
<br /> Part 11......................TMV...........................
<br /> NSC...................................................................................:.
<br /> ..............................................................................................................................................................Census T�act No.
<br /> Work........................................................................................................................................�.
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<br /> �rnm�e wun wr�o�nereaa o�w��
<br /> RE�EjRDERS ME 0:
<br /> ,�'�-���,� � � ) �
<br /> '° �... ,���9n�..�„, � .��.
<br /> Reg.of Deeds ����-.
<br /> 1 hereby cprt,ty' t;;is to be a tr�e and co����� �
<br /> State of JJFb;�sf�a ..Lt c.�pY of the ori�inaf (iied with the
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<br />��gned i� :�1� ; :, , ; y - - �_ Ti_�:,�� l_. LO�c�;�ra
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<br /> __------_....i,�;.�.�ry Fut�liC
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