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<br /> ' ,r , PHS-798 (VS) Reu. 4-48. Federal Security Agency, Pu61ic Health Service. (�ontaining 475 printed words}
<br /> ;NO. iBB-THEAUGUSTINE[O.GRANUISL�NU.NEBI1. � � � �
<br /> . 1
<br /> � TATE oF r1g88A5KB
<br /> �,�r Filed in the o�ce of fhe Register of Deeds the 2,� day
<br /> CERTIFICATE OF DEATH � ��� Ha�-� of Apri �y'� 19 ,�j0, and recorded in Miscellaneous
<br /> � Record No. Q ��on�1y`agea'��2. � /J
<br /> OF � , ���✓�'�-�-,-
<br /> � Register of Deeds-�QQ�q�
<br /> Augus� Albert Kru1l ► ��p
<br /> � App[ies to R. E. Description By �� '(�. �� Deputy.
<br /> � •
<br /> - - - - - - - - - - - - - - - - - - - - - -'- -uiz:- - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - -
<br /> STATE OF NEBRASBA
<br /> � DEPARTMENT OF HEALTH
<br /> Birth No. �2° sureau ot vitat stat�sttcs Siate Fi le No.
<br /> 1. PL CE OF EATH 2. USUA RESID NCE ( ere decease live . f instrtution: resi ence e ore a misston�.
<br /> a. COUNTY Hall a. ST:1TE N�,braSkg b. COUNTY H$1,1,
<br /> 4. Cl'fpY� (If outside corporate limits,write Rural). c. LENGTH OF STAY(in this place) c. CI�Y� (If outaide corporate limits,write RURAL)
<br /> TowN �.rand I s1�nd I 7 dd,V S TOWN Gr n T
<br /> d. FULL NAME OF (If not m hosprtal or tnstttution,give street address or ocation) d. STREET �"�' 81$ C�
<br /> HOSPITAL OR ADDRESS ����a����e lceation)
<br /> INSTITUTION Lutheran H�91J�t'i9�. 2
<br /> ,
<br /> �.�l�AM F a. N�rst) . (M� e) c. ( ast) 4. OF Month) ( ay) ( ear)
<br /> DECEASED DEATH
<br /> (Typ�o�P�int) August Albert Krull �Mar. � �1, lASc� .
<br /> 6. SEX 6. COLOR OR RACE 7. MARRIhD,NEVER MARRIED, 8. DATE OF BIRTH 9. Age(In yrs. If Under 1 Ye��Jnder 24 Hrs.
<br /> WIDOWED,DIVORCED (Specify) last birthday) Mos. Days Hours I Min.
<br /> Male ( white I marr9�d �_1i._��,R1j. 68 � I
<br /> 10�. USUAL OCCUPATION (Give lund of work done dunng 106. KINll OF BUSINESS OR 11. BIR H=(-'Gi�y, own or county)(State or foreign 72. CITILEN OF WHAT
<br /> most of working life,evrn if retired) I INDUSTRY PLACE country) COUNTRY?
<br /> Retire� railroad�r , railroadin� Wood River, Nebr. U. S.
<br /> 13. FATHER'S NAME 14a. MOTHER'S M DEN NAME 74b. NAME OF HUSBAND OR WIFE
<br /> Ju11us Kru11 I No R��ord I Z�.ola Fu1mPr Krn��,l
<br /> 16. WAS DECEASED EVER IN U.S.ARMED FORCESY 16. SOCIAL SECURITY No. 17. INFORMANT'S NAME or Signature Address
<br /> (Yes,no.Oor unknown) I (If yes,give war or dates of service)
<br /> 110 ZEO�.
<br /> 18. CAUSE OF DEATH MEDICAL CERTIFICATION Irc!ewal Between Ons�t
<br /> Enter only one cause per and Dea4h
<br /> line for(a), (b),and(c) �, DISEASE OR CONDITION
<br /> DIRECTLY LEADING TO DEATH• �e� I�eyocard3.tis _ _
<br /> •Tbis do�s not mean th• ANTGCEDENT CAUSES
<br /> mods of dyiny, such as
<br /> hsar! tailuro, asthenia, Agt�S
<br /> �tc. It m�nns the dis- DUE TO (b) -
<br /> ease, Inju�y, o� compli-
<br /> cation whieh eaus�d Morbid eonditions, if any, pivinp
<br /> � - � d�ath. � riselo the�abovs cause (a) stwtiny - .
<br />� � � �� � � the undsrlylny causs Iast. DUE TO (c) -__
<br /> 11. OTHER SIGNIFICANT CONDITIONS
<br /> Conditiions contributinp to the death but nct
<br /> rslaled to ths disease or conditton eauslnp d�ath.
<br /> 79a. DATE OF O ERA- I 19b. MAJOR FINDINGS OF OYERATION I 20. AUTOPSYI
<br /> TION
<br /> Yes ❑ No [k
<br /> 21a. ACC[DENT (Specify) 276. PLACE QF INJURY (e.g.,in or about homc+,farm. I 21a (CITY OR TOVJN) (COUNTY) (STAT'E)
<br /> SUICIDE ( factory,street,office bldg.,etcJ (If rural area,write RURAL)
<br /> HOMICIDE
<br /> 21d. TOIFME (Month) (Day) (Year) (Ifour) I 21e. INJURY OCCURR�D I 21f. HUW DID INJURY-0CCUR? � -
<br /> While at Work ❑
<br /> INJURY m• Not While at Work ❑ '
<br /> 22. 1 hereby csrtify that I attsnd�d 4hs dse:-2{s�e��om„ ;...._ ��" , 19�/►,ntaA �22• _, 19�.1t, tha! 1 las!s:sw th•
<br /> daceased slive on- _.L-.°: . ' , 19 � ,snd lhat dsath ooeu��ed al�i�lu.p�n.,f�om !h�eauses and on tb�dale statsd abova.
<br /> 23a. SIGNATURh (Degree or title) 23b. ADDRESS 23e. DATE SIC:NED
<br /> K. F. McD�rmott M. D. I Qrand Island, �1ebr. . I . ;'��,�,50
<br /> 24a. BURIAL,I:REMATION, 24b. DATE 21e. NAME OF CF.ME"TERY OH C:HbMATOHY 24d. ..00ATION (City,town,or couniy) (State)
<br /> REMOVAL (Specity) ,
<br /> burial. I 3-2�-50 I Wood River Wood River. N�bra��aka. +
<br /> DATE RN C'U 13Y LOCAL REG. REGIS7'RAR'S SIGNATURE 25. FUNERAL DIRECTOR'S SIGNAI'URE ADDRESS
<br /> AP�'-3-195� I -�".,.. S, Wh.j.�� I Livin�ston-�onderma.nn, arand I�,l�na, nt�►h,�AQkm
<br /> TO BE ACCOMPLI�HED WHEN BODY IS EMBALMED
<br /> 2�. T hereby certify I persona7.ly embalmed the body of the deceased named her�`m.
<br /> James D. Livingston, Liaense No. ].g,�3�
<br /> T1�IS CERTIF'SES THE AHOVE TO BE A TRUE COPY OF AI� ORIGINAL CERTIFICATE ON FILE WITH THE STATE
<br /> DEPARTMENT OF HEALTH, BUREAU OF VITAL STATI�'�ICS, WHICH IS THELE(�AL DEPOSITORY FOR VITAL RECORDS.
<br /> (CORp) Frank D. Ryder M. D.
<br /> (SEAL) DTRECTOR OF HEALTH ANDSTATE
<br /> REGTSTRAR
<br /> LINC OLN, NEBR,ASKA APR 1'�, 1954
<br /> Cer�i�'ica�e of Death pertaining to that part of the Easterly One-half of Lo� 5ev�n ('�), Block
<br /> Eight (8) , Original Town, now City of Grand Ialand, Nebra.ska, reeord�d in names of Augu.st A. Rru11
<br /> and Z�ola Kru11, as Joint Tenant�.
<br /> Filed for record this 25 day of April 1950, at 1:,�,� o'clock P.M.
<br /> ��,�, ���
<br /> ,;�
<br /> REGISTER OF DEED3
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<br /> , Deputy
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