1. Decedent's name: Emeralde Gertrude Evangeline Breitinger
2. Sex: Female
3. Date of Death: November 22, 1989
4. Time of Death: 12:23am
5. Social Security Number: 476-66-4554
6. Age: 85
7. Date of Birth: July 1, 1904
8. Birthplace: Siren, Wisconsin
9. In US Armed Forces?: No
10a. Place of Death: Hospital
10b. Facility Name: Hennepin Co. Medical Center
10c. City: Minneapolis
10d. Count of death: Hennepin County
11. Marital Status: Widowed
12. Spouse: Grant Breitinger
13a. Usual Occupation: Homemaker
13b. Kind of business: Home
14a. Residence State: Minnesota
14b. Residence County: Hennepin
14c. City: Minneapolis
14d. Street and number: 4544 4th Avenue South
14e. Inside City limits?: Yes
14f. Zip Code: 55409
15. Was decedent of Hispanic origin?: No
16. Race: Caucasian
17. Decedent's education: 9th grade
18. Father's name: Charles G. Peterson
19. Mother's name: Alma Almquist
20a. Informant: Mrs. Alice Peterson
20b. Informant's address: 1420 Terrace Drive, Roseville, Minnesota 55113
21a. Method of Disposition: Burial
21b. Place of Disposition: Lewis Cemetery
21c. Location: Lewis, Wisconsin
22-26 signatures of those involved
27. Cause of death: Enterococcus Sepsis and Pneumonia
No autopsy performed-natural death