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<br />_�__'�871---SIA=I�_zQ�4.ANAL C�MPAl�Y LINCOLN NEB._,,.. -: -: =-- _ .. _- __.�....,---___._�._«___ -- .
<br /> and deed of the sa.id �odel La.unary Company, a corporation, for the purposes therein set fort�.
<br /> WITNESS my hand a.nd seal on the: date above mentioned.
<br /> C I earY ��
<br /> (9E AL) J. L. !
<br /> Notary Publ�.c
<br /> My commission e�ires April I� ,1929.
<br /> Filecx for record this 11 day of February 1925, at 4 o� clock P. M.
<br /> ���� �
<br /> Register o Deeds�
<br /> -o-o-o_o_o_o_o_o-o_o-a-o-o_o_o_o_o_o_o-o_o-o_o_o-o-o-o_a-o-o-o_o-o_o-o-o_o-o_o_o_o-a_o-o-d_o:.
<br /> CERTTFIED CCPY C�' L�AT?i CERTIFICA?'E
<br /> iTEBR�.SKA STATE DE?'ART'�4E�?T OF HEALTH
<br /> CHARLES �'7. BRYA�v' ,G4VT'FA?JR
<br /> DIVISIv�? GF VITAL STATISTICS
<br /> C�'P�TIFIED C�PY ��' �TATH CERTIFICATE
<br /> I Place of Dea.th
<br /> Cour�ty of Ha.11 ' Re�istered �To 1976
<br /> To��mship-------- or Village -----------------or ;
<br /> Ci�y------_____ �To------------------- St. -----------'?Pard----
<br /> � If death occurred in a hos�ital or institution eive its name instead of
<br /> ( street and nu�7lber) ��
<br /> 2FULL NAt�� Helen�� Toba,n
<br /> � a Residence. No. ------------------St. ,----------------tiYard------------------------
<br /> �Usual place of A���e) (If non-resic�ent biver� city or toti;rn and state)
<br /> Length of residence in city or tocan �here d�at� occurred: yrs, mos, ds. Ho�r long in U. S. , if c�f
<br /> forei�n Lirtr yrs. :nos. �{s.
<br /> Pers�.�nal and stdtis-�ical pa.rticulars
<br /> 3 Sex 4 Color ar Race 5 Sirl�le,��garried,""idovaed
<br /> Fe�r�,le "'hite or �i vorced,'arite the word.
<br /> L'�.r ri ed
<br />, 5a If u��rrie�,t�ido�re:�' ,or �i�raarced '
<br /> Husba.n a o f 'iri do��ed
<br /> ,,
<br /> or '"ife of
<br /> ra.ted of Birt� �onth,Tay and Yea.r ,
<br /> Au�ust 1� ,1�E0 .
<br /> 7 Age Ye�rs '_�ROnths D�ys If less th�n
<br /> 1 day h r s
<br />�• 62 or min.
<br /> f�ccupation of Dec��.sed
<br />' ( a) Traae,prof�ssior�,ar ;
<br /> i particular kinc� of r��ork Housev�ife
<br /> (b) General r_atur� of industxy
<br /> business,or est�blish.,�:e..t
<br /> i-� ?:�:ich e:r.�loyed (�r e��pl��yer) ,
<br /> c) �T� �e cf �r:�Io Ter
<br />� Q �irthbla:ce City or tosvn
<br /> ( 5tate or Co�antrv) GPr:r.�ny
<br />; 10 :�'�me of F�.th�r J. �chroder
<br /> i 11 Bilthplace �f �'��ther
<br /> (City or �o�Fan)
<br />� � State or Country} GermanY
<br />' 32 a�.a.i,�en af �,iother Ur_„r.o�m
<br />' 13 Birthplace of i�c�hEr
<br />� (City or to��n)
<br /> �S�ta.te or Countrv) �ei:^anY
<br /> 14- Inform�.nt '.irs. U�arj,� Uden
<br /> �Ac'czress) Junia.tasglPbr. _
<br />, � 15 File� Feb 1Z,1Q23 T. T. :��ZcCleerp
<br />� ' Re�istrar
<br /> �:edic 1 Certi�'ic�te of =' ,a.th
<br /> 1 Datea of Death :":Rorth da� and ear Feb. I 2
<br /> ' 1•� I Hereby Certify,T"�,t I at+e:��e�:? deceased from
<br /> Jan. l ,1923 , to Feb � ,1�23 �hat I last sG.�v her alive on
<br /> Feb �,1923 and thc.t de�.th occurred,o� the date stated
<br /> G i�ve,at 1: 30 P. %,4. ?'he cause of death z�a.s as follor�s;
<br /> En��:�carc�itis ( duration) yrs. :;.os. �- ds. ,
<br /> Contributory Erorchia.l Asthma
<br /> : ( Seconc.arv) ( d:uratio:�� � Yrs,:nos. d.s.
<br /> 1 �'he re vlas r�isease �ontracte� if not at place of , _
<br /> �ea.th Place �f �Aa.th
<br /> Did an Operatio��1 pl ecede Death no i�ater� of-__--_-_
<br /> T"das there a,n Autansy no .
<br /> a'lhat Test Confir��ed Disgnosis clinical syr.��to�ns
<br /> ( Si�ned) Royal F. Jester, '?. D.
<br /> 1� ( Ac�dress Doniphan,Neb.
<br /> te the aisease causi�^l� d.eath,or in deaths fror:� vioien�
<br /> ca.uses ,state (1) :neans and nature of in;r�ry,and (2) ' •
<br /> v�hether acca.dental ,su�.cidal or hosnicidal.
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