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86- 108�l9� WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. DATE OF ISSUANCE APR ^ -: t g86 STANLEY S. COOPER,'DIRFCTOR LINCOLN, NEBRASKA BEAU OF VITAL STATISTICS OR RS M� RR& Deeds STATE OF NEBRASKA DEPARTMENT OF HEALTH BUREAU OF VITAL STATISTICS CERTIFICATE OF DEATH DECEDENT - NAME Fe MT KIDDIE--------- uSt-- �5[[- - - - -_- w DEATH Dar Y•I V i l OAF RACE -I. R . wba.. RI..1. Aa.r— ORIGIN /DESCENT (• tl.l•ew, r...ae.. I AGE -1..• R.wu.• I UNDER 1 'EAR UNDER I DAY DATE OF 4611TH (w . D.,. r• I T . •k I ISq..l1) Gwr...k)($, --F,I Ir..I I NOS DAIS � «OU1S; WNS ite S �' i4 69 1es a< 1, Apr. 7, 1916 ND STATE OF 111TH IN ..r .. U S A , CIFIIIN Of WHAT COUNTRY; MARRIED. NEVER •ARMED. � NAME OF SPOUSE (11 d.. P.. -,d... ....I ..-Y) ;w1DOWED. DtV01C[OfS —Irf tchell S. Dakota I �o USA ,ID Married „ Grace A. Devereaux L SECURITY NUMBER USUAL OCC ATIONfG...,•wd d.w. d.w. d..-.1 .w... RIND OF BUSINESS Of I"USTRY COUNTY OF DEATH ./�...wB I.F. ...w .l ..n..d) 12506-09-5080 Is.Pres. E uitable Bldg 6 10anj13bFinance Company-1b Douglas TOWN 00 DEATH IN5IDICIT/1W1T5 iHOSPITAI OR OTHER INSTITUTION - N.n•fl /.e1w..rA... iQ.•...ti OfrfTb w��AS.r,.i INN...• I $.w•Ir'.. w Nel V••..1• N ewd w.•we..l mah _ 11k Yes i14Clarkson Hospital i1» Inpatient rl—f—�f NCE -STATE COUNTY CITY. TOWN Oil LOCATION ST1EfT AND Mumble !INSIDE CITY SIm1T$ ebraska I(Sp..d r.. e, Net 1Sb Hall IS. Grand Island l,sd2304 W. John St. 5♦ Iles R -NAM I MIDDLE LAST mc)-f. - mA10EN NAml FIRST -ODLf u Tho mas Francis Kinman tT __ Bertha J. Matz S DECEASED EVER IN U S AWED FOR[lS? INFORMANT -NAME - fELA 60; $Wl. mAl11NG ADDIESS srnfr W T 1 D W C- OPTow« st -I 1- 6 8p1 , Ws ;.Ne8r., II 12/30/41- 6/24/45 .',,Grace A._Kinman,_Wife. 2304 W. John St.� rand sland BURIAL C..wwr.ew, R. Alf CfMETERT OR CRImATORY NAME LOCATION CITY OR TOWN STATE 2D. Burial x*A r. 2 1986 2D. Grand Island Cemetery_ ;2Dd Grand Island. Nebr.-_ EMBALMER- SIGNATURE a LICENSE NO IUME1Al HOME - NAmF AHD ADDLE SS STH[T Of .1 D ..O C•TT OS 10- STATE 11.1 Swanson - Golden Mortuary Omaha,NE for 6ggQ1 21. a /,S 22 Apfel- But_ler- Geddes, 1123 W. 2nd, Grand Island, L '-i DATE OF DEA [me. D.Y. Y.) F DATE SIGNED (me Del. Y• I i HOUI OF DEATH 1 °V3 i 2u n. March 30 1986 -0 2.. l: : - _ -- DAVIS NED(Af...D.I.T.) HOUR Of Of AT" _i PRONOUNCED DEAD PRONOUNCEDD1AOf. -,i S 'I April 1 1986 122. 8 M z' 2.. 124 M ii nb T.0. ►...F ., S...I•.... d .w W .Ia. W ... •. ... A 0 �Q .. w. M ....- .....Nr« r....�.r..• .. F .. +r N.w a..•.N w �M �� .•...IJ ..rd • . w. ..r .r .4 «. er ...mM.wal«.rm. NAM ANO S Of CEtTI 1PNYSICIAN. CCF1ON1Ir5 PHYSICIAN OR COUNTY ATTORNEY) ( T,y. w P..11 2 Vincent F. iscia, M.D. 650 orth Tower Doctors Bldg. Omaha, NE 1IGISfRAR DATE RECEIVED BY REGISTRAR /M.. Dor. Y. I APR 3 1986 2M.If•,.r«.e� 7eb MwEDIATE CAU (ENTER ONES ONE CAUSE ►E1 NE FOR (.). (b). AND (U/ N....N A.1.... .•... W .ww PART (.I p -- L it � �6�.a- Ca...7•r�i� E To. OR AS A ICONSMUtHC E OF 1......I A.o......r .r drw w1 - DUE TO. OR AS i ON NCI Of ""^'I ei""'• """"'' •'� d"w 11 PAST «.1 N.KAN COWIfIOM/ -C md•r.... 60-, a ...1. b.. r ..I.w•1 .AE 1S o rfMAlf. wAS THEN A AutO•SI vA$ USE SfHSS1D t0 NEpCA1 ..lGwHCT 1N Tw! .AST S..OHT «Sr IS...Ar ra «., E� VP M CO.O.NR D ' yes !. N. : 2B ACCIDENT. SUK101. «0.1[10!. -011 DATE O• «Alm' IM. O•, •, 1 «OW O. twu.+ OfueS..gw -U., OCcu NRD OR HN1010 `NV*S W1 . .-I" Sp.. 13M 3a lUUSY AT W01R lS.rI1 rr r mN .,••...•.•1.•M- w tSn«Ar• 13M _322 - - I