Loading...
HomeMy WebLinkAbout1970 ~ SCATE OF NE[iE'cASKA-DEPAItT!1fE?YI'OF lIEALf H '1891"79 , ' . Bureae of 1'ital Stalistics i ,N CERTI FiCATE OF DEATH d s,.n K ~[~[A$f~-NI{M[ ~~tll r~01~ l~fl . SEX CATE OF DEATN ~ ~OMtw, O~r, qw~ 1 ~ Jo~n i-~ed Goattsche : I~~ale Nove~ber , 1969 ~ RACE .nun. Mecro. •••e~x.M ~weur, wGE-i.sr ~.a~ ~ re.e v..oe~ ~ wr OF tIRTM i.wwrw. sa~. COUIii~ Of OEAM ~ ac. ~ sncx~ ~ u.na.. .e•es ~..os. wn wwa~ ..r. . :lhite ~5 k ~ Jan. 25. 19d4 all `'i ~ . C111f, tOM~N, OR IOCATION Of DEATM ws~w tm urrts Np511TA1 O~ OTHER NSTRUIION-HAME ~u wr w~~j~, o~ve sntt ~wwta srecn+ .n o~ ?w ~ ^ ~ „ r m . ~ ~ Grand Island Yes St. Francis Aos~ital ~ o sute oF uRrn ~ u«o. ~M v.s .,~...e CIi12EN Of WNA~ COUNiR~ w?e~o. NE~ER r+~ARRIED. SuRVnr~ srousE ry.~, pc.e rn` cowm~ wWOwED. o~uecrr, . T'~braska. USA ilido~ ~ ~ c, v SOCW SECURRY MJ~6ER USUAI OCCU?ATION ~wve iues o+ w~e ooNe ow~.w rosr d KM~O OF WSwESS p[ 1 3 C m .w~..c un, Mw M Ht~tlO 1 ~ ~06-0 - 8 ~a Radio Re airmr.ui Re r C z c~ ~ES~DENCF-STATE ~pUNiY Uir, TOWM, OR tOUT10N ~"s~ ~.~m STtEE ~1 ~ s?ECU~ .es oe wo p ' - ~ ~ ,M Ptiebra~ka ~o Hsll ~k. Grar.3 I~l~rtd Yes ,a ]~f j tti'est•Ch • t. FwiHER-NAA+F ~~~yt rioo~t ust MOiNER-MAIDEN NAME npt ~ .upott Dfb ~s John ~ Goettsch Dora Wi::dol •h INFORINANT-HAMf-tEtAfIpNSHN MwltaK, AOORESS ~s.«~r o~ ~.r.o. .ro., cm p wrr, s~.n, sr? 'I ::rs. Jerrv K - Dau _hter ~n 250Q ?=ioneer Blvd. Grand Islar:d, I~ebr. 68801 P+ttT t. pf~;ty rt~5 GtiSfD S1f: ~FNift Or+! r O.vF C~cLKE rEi IcvE Fi.i o', ib), A-~ (c .~~eoa~wn wr ,u ~ ( ~ A ~irnn~ oru~ ~w oe~m rrtOUR C~YS! ~ ` • / / ~ ~ ~ ~ i . ~ 4 . ¢ .~Lt C~.d O~ , ~ 9 ~.~o~u~~~ _ . , . ~ - ` ' , oroawMs. ~r .~n. ~ _ .¦~c~ c.vt ~nt ~0 1b1 r ~rrtD~~1F C~Yf! 101, py~ f0, ~1 Qu!'K! O~: 5~~~~MG 1M~ VMDl~- ~\IMG (~YS! Uf1 w ~ ~/~tT M. OTME~ SIGM1iKA!(T COHp~~ONS CONTtlW11NG TO OEAiM MOi lEtAfED ?AtT M. If fEMAIE, WAS TNEIt • AUTOKr IF 11E5 r[~e ~~~+O~r/Gf CO~ t0 CAUSE GIVEN W~AtT K~) ~t[GW~MC1 IM TME ~/1ST ] MONTNSI ~~tf W~+0/ LO[~IO ~N Oti[Wluer6 4YSt q OlnTM ~ES C] NO O N~ 11~ wCCtDEM, SUK~OE. F~O~NCJDE. OA NlUR1l ~..o..r¦, p~~, •e~~ ~?IOIIR MOW INIURt OCCURREO ~ e.nee .urur d iun u. ru* ~ o~ r mr ~ Ot ur+oElERl~wEO ~vecus~ 70~ 1w. llt. M. 7M. INJUlY AT WOR[ ~uCE of e~nAtr.+..o.e, r..,., srqi., ~.Raer, IOC~i10t~ ~snen o~ ~.r.o. «o., an oe ro.u, u.a~ 1 SI(C~N Rf O~ NOI OHK! MDG..l1C 1 S/lClf~ 1 - . 7r1 7N ~l CERTIHCwTqN- ..wrn wr n.e ..o..w o.~ •w 41f yM If111/M(~ u~ d. ~ o~otoro .at .~n+ nw oEwrN otcueeeo wi nu run, p, e~ " ~/MtSK1~N: TO r~r.n~ on? rtu ~oor .~n~ a.n.. ~„ow~ o~n, ~..o, p s~t ~eu p. c.n~n~ou. eue ' «~~i.o~.~. Oct. 19 1~JG Hov.4 19G9 ~~~11-~1-GJ ~ ~ ?_q CfRT1f~CAiION-wt4OKAt E7IAMiNER O! ~ORONER: oa rMt us~s or n! ~ ~^H c.ux~s~ sr.we. MO4t M Ol~M 1 [OtM W~3 ~~0~'OVMClO O! ~....~....o.. a n.e wo• ..~oio~ +~e ~...ane.ro«. ~M .n w..a... • n.~ ww o~~iw pC[ut~tG Ow M Wit u~0 Dut q n4 4uSl~S~ S~~RO. M ' M. ~E4Ttf~fR-wAh~E rtvr~ c~ ?awn SIGNATU p[p~te p~ nt DAiE 51 O ira+u~, w~, r[.~~ m D. P. .;Tatson N. D. ! . 6 ~r~.GwG ~DORESS-CERtr/1ER sr~Eer o~ ~_r_o. ..o. u~r o~ w~r.. sun 10 ,dest ICoer.i St. Grand is_andr l;ebra.~;a 88d~ " tuR1At, CREMATqN, ItFMpvwl CEMEiERY OR CREMATORT-NM~E tOGDON un p pwr s~•n ~ snc~ ~ yurial Gra-.d Is2~.r_d Cit r~. Crar~d Is?and,i~ebraska QA~E ~~w*~, o~+, n~u~ FUNERAL HOME-NAME ~NO ADDtESS ~ Sf~~ll O~ ~.f.0. MO.~ C~ O~ ~OMM~ sr~+e, nr ~ ru .:ov. 8?96 Livin~;st~r.-Sondereann's 505 N.koeni~, Gr~.nd I~land,I~ebr. 68801 ~ fMSA1MEA ~SKrNAiURE ~1fC~ NSE NO. 18^ REGISTRAR-SIGHAiURF ' QAfE ~~K7ftv(O ~r IOCAI lEGISTUU ~Sb. ( / 2M c ~--~/~j' 74. if~/D/ /C/~j ~ / % GL~ G ! ` ~ - - - - - - • _ _ . ja: THIS-6ERTIF~/E$~THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL , CERTI~ICAT~FQN FILE WITH THE STATE DEPARTMENT OF HEALTH, ~ BUREAU OF VI'tAL STATISTICS~ WHICH IS TI~E LEGAL DEPOSITORY ~ FbR VITAL R~ORDS. - . ~ • ~0~1~~ ~~~1~6~ . _ _ . . ' DIRECTOR OF VITAL STATIST~CS AND ASSISTANT STATE REGISTitA.4 _ ~ - . LINCOLN, NEBRASKA j~;;ued January l~j~ 1970 . ~ ~ r ~ _ ~ . ~ ~-S~ , . . . ~ . . _r_ ~ ~ _ __w~