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<br /> PHS-798 (VS) Ren. 4-48. Federal See�rril�/Agency, Public Health Service. (Containing 475 printed u�ords)
<br /> NO. 188-�THEAUGUSTINECO.GRANDISL�ND.NEBR. �
<br /> I 1'A?� Of t�E88AgltB Filed in the o,�ce of ihe Register of Deeds the 2.'r> day
<br /> CERTIFICATE OF DEATH � ��� I3R�.1. � of A�?r �g 19 5O , and recorded in Miscellaneoas
<br /> F � � Record No. �+ ��on`Ph�C�01, •
<br /> � , ��/��
<br /> � Reqister of Deeds-�pC�.
<br /> Anna M. Stiller �
<br /> � App(ies to R. E. Deseription By ����.-L �. �� Depttty.
<br /> � Lot 1, Block lo, Windolph� s Add.
<br /> - - - - - - - - - - - - - - - - - - - - - -'- -oiz:- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
<br /> STATE QF NEBRASBA
<br /> DEPARTMEIV'i` OF HEALTH
<br /> Birth No. 1z6 suresu ot vita�stat�sttcs State File No. �9-010926
<br /> L P E OF FI 2. USUA R D N E ( ere ecease iv . f institution: resi ence ore a m►ss�on).
<br /> a. COUNTY Hc�l 5-346 a. S,-.,�E NEbr b. COUNTY Hc'��.
<br /> 4. CI f�Y� (If outside corporate 1'units,write Rurap. c. L.ENGTH OF STAY(in this place) c. CI�Y� (If outaide corporate limits,write RURAL)
<br /> TOWN Grand Ialand I SDYr� TOWN Grand Island
<br /> d. FULL NAME OF (If not in hospital or inatitation,�ve atreet address or Iceation) d. STREET (If rurat,give lceation)
<br /> HOSPITAL OR ADDRESS
<br /> INSTITUTION �16 N. SyCamor'� 1.101 W. John ___
<br /> �. M O a. ust) . ( ia e) c. ( ast) 4. � Month) ( ay) (Year/
<br /> DECEASEO I
<br /> (Typ�o►Print) Anna M. Stiller ! DEATH NOQ 19�9
<br /> 6. SEX 6. COLOR OR RACE T. MARRIED,NEVER MARRIED, 8. DATE OF BIRTH 9. Age (In yrs. If Under 1 Year If Under 24 Hrs.
<br /> WIDOWED,DIVORCED (Specify) last birthday) Mos. Days Hours Min.
<br /> F I Whi�e I Married Feb 28, 1873 I 76 8 � ll �
<br /> t0a. USUAL OCCUPATION(Grve k►nd of work done dunn 10b. KINll OF BUSINESS OR 11. BIRTI-I- (Gity,town or county)(State or forei a 12. CITILEN OF WHAT
<br /> most of working life,even if retired) INDUSTRY PLACE country COUN RY� ,
<br /> YlOLiBEW�.f G g I - I Hanover, �ermany 8 I U. �• A.
<br /> 13. FATHER'S NAME I 14a. MOTHER'S MAIDEN NAME I 14b. NAME OF HUSBAND OR WIFF.
<br /> Henrv Pannj n� - f Jos�ph P. Stiller
<br /> 16. WAS DECEASED E R IN U.S.A ED FORCESI 76. SOCIAL SECURITY No. 1T. INFORMANT'S NAME or Signature&Address
<br /> (Yes,no,or-nknown) I (ff yes,�ve war or dates of service) _ Joseph P. Stiller Grand Tsland
<br /> 18. CAUSE OF DEATH In!�wal B�twMn Ons�t
<br /> Enter only one cause per MEDICAL CERTIFICATION and D�ath
<br /> line for(a), (b),and(c) �, DISEASE OR CONDITION
<br /> DIRECTLY LEADING TO DEATH• virus pneumonia 10 days
<br /> ca�
<br /> 'Tbis doss not mean!Ae ANT�CEDENT CAUSES
<br /> mods oi drinp, sueh as
<br /> hsart failu��, asthen�a, secondary anemia �' yr8•
<br /> �tc. It mss�ns ths dis- DUE TO (b) -
<br /> ease, injury, or aompli-
<br /> eation which eaus�d Mo�bid eonditions, if any, pirinp
<br /> d�atb. rls�to tho abov�esus�(a) statinp -
<br /> !h�und��lyiny esus�last. DUE TO (c) ---
<br /> 11. OTHER SIGNIFICANT CONDITIONS
<br /> Conditlons eont�ibutiny to ths d�ath but eet q
<br /> �slatsd to the dis�aae o�eondition eausiny d�atb. h�.'p f raeture--�.A.� months a.��
<br /> 18a. DATE OF OPERA- I 19b. MAJOR FINDINGS OF OPERATION 20. AUTOPSYI
<br /> TION
<br /> Yes � No �
<br /> 21a. ACCIDENT (Specify) I 21b. PLACE QF INJURY (e.g.>in or about home,farm. I 21a (CITY OR TOWN) (CUUNTY) (STA1'E)
<br /> SCIICIDE factory,street,office bldg.,etc.) (If rural area,write RURAL)
<br /> HOMICIDE
<br /> 21d. TIME (Month) (Day) (Year) (Hour) I 21�. INJURY OCCURR�ED 27f. HUW DID INJURY OCCUR?
<br /> OF While at Work Q
<br /> INJURY m• Not While at Work ❑
<br /> 22. 1 h�reby e�rtity tbat�1T sit�nd• ths deeeasod irom � tg , tn �OV. 8 _, 19�, lhat 1 I�s!s:aw th•
<br /> dseeased siivs on j��4 � t9 and tAs!doath oeeur�ed a ��ti"do�rr�lA�uses and on ths date stabd ebovs.
<br /> 23a. S1GNA1'URh (Degree or title) 23b. ADDRESS 23e. DATE SIfNED
<br /> C. E. Mikel D. -0. I 219� West 3 S� Grand Tsland I Nov. 9� 19�9
<br /> 24a. BURIAL,I:REMATION, 24b. DATE 24c. NAME OF CEMETERY OH G1i�MATORY 21d. ,.00ATlON (City,town,or county) (State)
<br /> REMOVAL (Specify)
<br /> Hurial �ri. Nov.11.19�9 Grand Tsland Cemeterv Grand I$land, Nebr.
<br /> DATE REC'D liY LOCAL REG. I REGISTRAR'S SIGNATUR 26. FUNERAL DIRECTOR'S SIGNAI'URE ADDRESS
<br /> N Ov �h 1q1�q �. S. Whi�e Gedde s Funeral Home Grand I sl and, Nebr.
<br /> 25. I h�r�by eertify I personally embalm�d the body of the deceased named hereon
<br /> Irwin B. Pe�erson •
<br /> License No. 1826
<br /> THIS CERTSFIES THE ABOV'E TO BE A TRUE COPY OF AN ORIGTNAL CERTIFICATE ON FILE WTTH THE STATE
<br /> DEPAP.TMENT OF HEALTH, HUREAU OF VITAL STATISTSCS, WHICH IS THE LEGAL DEPOSITORY FOR VITAL
<br /> REC ORD S.
<br /> (CORP)
<br /> (SEAL) Frank D. R�rder M. D.
<br /> � DTRECTOR OF HEALTH AND STATE REGISTRAR
<br /> LTNCOLN, NEBRASKA APR 2� 1950
<br /> Fi1ed For record this 2� day of Apri3 1950, at 10:I� o� cloek A.M.
<br /> ''�{ REGIST�F,R OF DEEDS
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