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Home My WebLink About20081349NUM PGS DOC TAX CK# FEES , SO PD~~ ~~ CK# CHG ~ ACCT #_,~y2, RET FEES: CASH RD.D. CK'/#,,~c / RECD -S ' ~.~1 ,~k~Kf RETURN ~ ~ 8 I~~IVI~VI~MnIYVIIY~I~~~ PJUM L~-7-~~ _ RD. COMP ~ ~~~ ~~ ~y COMPARE ~~ CADAS _ AO ADAMS COUNTY, NE FILED INST. N0.-,~ .(~,rj,~,~, c~ ~~ Date ~-D8 Time 3 jB~°~ ~~' REGISTER OF DEEDS WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND-HUMAN ~EIi4~l~ES SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL REGOItD-QN F.KE W-TH THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS_TiC~SI€~T-!A!$T;":N/~ll~L1 THE LEGAL DEPOSlTORYFOR VITAL RECORDS. -- y =~_ DATE OF ISSUANCE _ _ _ _ ~/~La~~~, ~ANLEYS: COOPI~R~-= MAR 2 5 199 ASSIS~AN1"BTILTE REGIS~RAR_= LINCOLN, NEBRASKA HEALTH AND HUMAN ~E171i7~~~'PSTEM STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SERVICES FE+FANCE~AND SUP~ItT VITAL STATISTICS - -_~- -- CERTIFICATE OF DEATH 2008134 1. DECEDENT -NAME FIRST MIDDLE LAST 2. SEX 3. DATE OF DEATH lMOnlh. Oay. Year) Naomi Rhae Zimmerman .Female March 16, 1998 d. CITY AND STATE OF BIRTH 111 not yr U.S.A., name country) 6a. AGE -Leal Blnhdey UNDER 1 YEAR UNDER I DAV 6. DATE OF BIRTH /Month. Day. YsarJ Oak, Nebraska IYre.l 76 6b. MOS. I DAYS 6c. HOURS' MINS. October 24, 1921 7. SOCIAL SECURTIV NUMBER Ba. PLACE OF DEATH 506-24-5766 HOSPITAL: Inpetienl OTHER: Nursing Home ----- - ^ 6b. FACILITY • Name /I/rrol inelitution. give sheet and number) ^ ER Outpatient ^ Residence Mary Lanning Hospital ^ DOA ^ Other /SpeaNr Bc. CITY. TOWN OR LOCATION OF DEATH 6d. INSIDE CITY LIMITS Be. COUNTY OF DEATH Hastings Yee ~ Np ^ Adams 9a. RESIDENCE -STATE 9b. COUNTY 9c. CITY. TOWN OR LOCATION 9d. STREET AND NUMBER (Including Zip Code! 9e. INSIDE CITY LIMITS Nebraska Adams Hastings 616 S Lexington 68901 Yee ® Np ^ 10. RACE - (e.g., Whlle. Black, American Indian. 1 t. ANCESTRY le.q.. Italian. Mexican, German, elcl ~ 12- ^ MARRIED ~ WIDOWED 13. NAME OF SPOUSE pl wile. give maiden name) atc.l lSpeciy) White I$peC1Nl American NEVER DIVORCED 149. USUAL OCCUPATION (Give kind of work done during most "~ I db. KIND OF BUSINESS INDUSTRY 1 16. EDUCATION ISpecity only higMel prude compleladl ~ o/ wor mg li7e, even it retired! 'I Seamstress ~ Garment factory Elements r Secondary 10-12) ~ College It -1 or 5•I r~ 16. FATHER -NAME FIRST MIDDLE LAST 17 MOTHER FIRST MIDDLE MAIDEN SURNAME + William H. Merrill Erruna Burkett 7B. WAS DECEASED EVER IN GS. ARMED FORCES? 19a. INFORMANT-NAME IYas~ poor unk.) ;n yes. give war and ogles of serviced Gerald Zimmerman t9b. INFORMANT MAILING ADDRESS (STREET OR R.F.D. NO., CITY OR TOWN. STATE. ZIP( 504 Ringland Rd Hastings NE 68901 20. EMBALMER -SIGNATURE 8 LICENSE NO. 21 a. METHOD OF DISPOSITION 2t D. DATE 2/c. CEMETERY OR CREMATORY .NAME ' I t ~f ~ ` ®Burial ^ Removal March 20, 199 Parkview Cemetery 22a. FUNERAL HOME NAME ltd. CEMETERY OR CREMATORY LOCATION CI7V OR TOWN STATE Brand-Wilson Mortuary ^ CremaCOn ^ Donal~nr Hastings NE 505 N Bellevue Hastings NE 68901 23. IMMEDIATE CAUSE (ENTER ONLY ONE CAUSE PER LINE FOR lat. Ibl. AND Icp I Interval between onset and deem PART I lal cl. ~ ~! Q (~~~ ~V~J ~ 1 ~ ,,~3~/~fn// DUE TO, OR AS A CONSEOU NCE OF~ I Interval between onset and tleath Ibl ~ S ~~ I ~~ /5 DUE TO. OR AS A CONSEQUENCE OE I Inl vat between onset antl death I I `"' OTHER SIGNIFICANT CONDITIONS -Conditions conlribWing to the death but not related PART PART III IF FEMALE. WAS THERE A I 24 AUTOPSY 25. WAS CASE REFERRED TO MEDICAL (//~ ~/,~/j/~~r/~ II /~r ~Y V ' f C ~~ PREGNANCY IN THE PAST 3 MONTHS? EXAMINER OR CORONER? N (Ages t0-541 Ves No Ves No Ves No 26a. 26b. DATE OF INJURY /MO.. Day Yt/ 26c. HOUR OF INJURY 26d. DESCRIBE HOW INJURY OCCURRED Accident ~ llntletermined M Suicide ~ Pentling 26e. INJURY AT WORK 261 PIACE QF.INJDRY - Al home. farm. street laclory oHHrce budding. etc. /Speciy) 26g. LOCATION STREET OR R.F,D. NO. CITY OR TOWN STA fE Hpmiclde Invesegaeon ^ ^ yes No ~ 27a. DATE OF DEATH (MO.. Day. Yr.) ° ~ ~ ~ ~ ~ ~ ~ " v i 26a. DATE SIGNED (Mo. Day. n.l 266. TIME OF DEATH M ~ J 27b. DATE SIGNED /MO.. Day. Yrl 27c. TIME OF DEAT ~ a Q Y 28c. PRONOUNCED DEAD IMO.. Oay. Yrl 28d. PRONOUNCED DEAD (Hour( O O T~ ~_ ~ ~ i, g g " V M ¢~ g M & 27d To the best of m kn e death occurred at ln 'm tl t l d d h ° ° .- . y g e a e ace an ue to t e causels) staled. ~~ ~ /~ / / ¢ ° 3 28e. On the basis of examination and-or investigation, in my opinion death occurred at the lime. date and place and due to the causelsl staled. I ISi nature and Tillel - / ~•! ISi nature and Title ' 29. DIO TOBACCO USE CONTRIBUTE TO THE DEATH? 30.a AS ORGAN OR TISSUE DONATION B EE N CONSIDERED? 30.b WAS CONSENT GRANTED? ^ VES NO ^ UNKNOWN I ~ ( ^ VES ~ NO ^ VES ~ NO 37. NAME AND ADDRESS OF CERTIFIER (PHYSICIAN, CORONERS PHYSICIAN OR COUNTY ATTORNEY( lTy a Priory 32a. REGISTRAR 32b. DA FIL RV REGj IF~AR /d/p Qayj'(.,(^~ ~r v /my 1 2UU813~9 A tract of land located in the City of Hastings, Adams County, Nebraska, described as: The North 50 feet of the South 225 feet of the West Half (W1/2) of the Northeast Quarter (NE1/4) of the Southeast Quarter (SE1/4) of the Northwest Quarter (NW1/4) of Section 13, Township 7 North, Range 10 West of the 6th P.M., lying East of and abutting the alley deeded to the City of Hastings by deed recorded in Book 102, Page 460 of the deed records of said County, and extending East to the West line of Lexington Avenue produced South; together with the East half of said alley, now vacated, which abuts the West line of said tract; all according to the Agreement and Quit Claim Deed recorded in Book 163, Page 277 of the Deed Records of said Adams County, wherein the correct description of this, and other properties, was formally agreed to and by said conveyance duly cleared of record ~b~