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<br /> PHS-798 (VS) Reu. 4-48. Federal Security Agency, Public Health Ser�ice. (Confaining 475 printed words}
<br /> NO. 188-THEpUGUSTINE[O.GNANDISLRND.NEBR.
<br /> I ?AT£ Of tJE88A5KR
<br /> �,�rv Fi[ed in the o�ce of ihe Register of Deeds lhe 19 dag
<br /> CERTIFICATE OF DEATH i ��0� H&11 of AU�?;UBt 1950 , and recorded in Misce[laneous
<br /> Record No. '(�,1 on Page 2�t`�O��.: 5 0 ' cIo ck A.M.
<br /> OF �
<br /> �
<br /> Regisfer of Deeds
<br /> John Joseph Newbi��in�; �
<br /> i
<br /> � App[ies to R. E. Description By Depufy.
<br /> � n�z: Lot 3--Block 15 Evans Add�.tion
<br /> - - - - - - - - - - - - - - - - - - - - - -'- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
<br /> , A'I'E ��'B
<br /> DEPARTMENT OF HEALTH
<br /> Birth No. 12 6 B reau of Vital Statistics Stafe File No.
<br /> CER�IFTCAT OF DEATH
<br /> t. L CE OF 2. USUA 51 N (W ere ecease live . tnstitut�on: resi ence e ore a misston).
<br /> a. COUNTY Hamilton a. ST:1TE Nebr b. COUNTY Ha.1.a..
<br /> �; �ITOYR (If outside corporate limits,write Rural). I c. LENGTH OF STAY(in this place) c. CI�Y� (If outaide corporete limits,write RURAL)
<br /> TOWN Philli s 2 hrs TOWN Grand Island
<br /> FULL NAME OF (If not in hospital-or institution,give street address or Iceation) d. STREET (If rural>give lceation)
<br /> HOSPITAL OR ADDRESS
<br /> INSTITUTION phillips �ymnasium E�04 E 5th-
<br /> �. N ME O a. (rtrst) . ( i e) c. ( at) 4. OFT Month) (llay) ear�
<br /> DECEASED
<br /> John Jose h Newbi��;in� DEATH May 3, 1950-
<br /> (TYp�o�Print) p
<br /> 6. SEX 6. COLOR OR RACE 7. MARRIED,NEVER MARRIED, 8. DATE OF BIRTH 8. Age(In yrs. If Uader 1 Year If Under 24 Hrs.
<br /> WIDOWSD,DIVORCED (Specify) last birthday) Mos. Days Hours I Min.
<br /> Male I White I Married June 16, i�go 59 10 � 17 --
<br /> 70a. USUAL OCCUPATION (Gtve lund of work done dunng I 70b. KINll OF BUSIN�SS OR I 11. BIRTH- (City,town or county)(State or foreign 12. CITILEN ON WHAT
<br /> most of working life,even if retired) INDUSTRY PLACE country) COUNTRY?
<br /> � Carman ,U.P.R.R. Co. Cumin� Co. Nebr U.3.
<br /> 13. FATHER'S NAME 14a. MOTHER'S MAIDEN NAME 74b. NAME OF HUSBAND OR WIFE
<br />� James Newbic��in� I Anna Isaacson ( Ze1ma Newbi�in�
<br /> 15. WAS DECEASED EVER I U.S.ARMED FOH(.ES`I 16. JVI.lAL �ni.urcii Y i�o. i r. INFORMANT'S NAME or ignature&Address
<br /> (Yes,no,or unknown) I (If yes,�ve war or dates of service)
<br /> ;�o __ Zelma N�wbi��inr� (�rand Island T�ebr
<br /> 18. CAUSE OF DEATH MEDICAL CERTIFICATION In!erval Betwesn Ons�t
<br /> Entcr onlY one cause per and Dealh
<br /> line for(a), (b),and(c) �, DISEASE OR CONDITION
<br /> DIRECTLY LEADING TO DEATH• �a� Coronary thrombos3.s _
<br /> •This doss not mean!be ANT�CEDENT CAUSES
<br /> mods oT dyiny, sueh as
<br /> heart iailu�e, astbanle, Art erio s cl ero s�,s
<br /> etc. It ms�ns tbe dis- DUE TO (b) --
<br /> ease, inJu�y, o� eompli-
<br /> eation which esused Morbid eonditions, if any, giviny
<br /> dsath. rias to the abovs cauae (a) stAtinp
<br /> the undeelylny cauas last. DUE TO (c) _ -____-
<br /> 11. OTHER SIGNIFICANT CONDITIONS
<br /> 1 Conditfons cont�ibuliny to the death but nct �
<br /> ���1 �elated to the disease o�condition cauatny death. � .
<br /> 19a. DATE OF OPERA- I 19b. MAJOR FINDINGS OF OYERATION 20. AUTOPSY`l
<br /> TION
<br /> Yes � No ❑
<br /> 27a. ACCIDENT (Specify) 21b. PLACE OF INJURY (e.g.,in or about home,farm. 21a (CITY OR TOWN) (COUNTY) (STATE)
<br /> SUICIDE factory,street,ofI'ice bldg.,etc.) (If rural area,write RURAL)
<br /> HOMICIDE I
<br /> I
<br /> 21d. TIME (Month) (Day) (Year) (Hour) 21e. INNRY OCCURR�ED 21f. HOW DID INJURY OCCUR? :
<br /> pg While at Work Q
<br /> INJURY m• Not While at Work ❑
<br /> 22. I he�eby ee�tify that I sitended ths deesasad from_ 12-1� , 79_7Z._ to 5�� _, 19�SL, tbat I Iaat s:aw ths
<br /> •
<br /> deeeased alive on_�--r'� , 79�, and tha!death oocu��ed a • �m.,Trom ths causes and on!he dats statad above.
<br /> 23a. SIGNA7'URh ( egree or title) 23b. ADDRESS 23c. DATE SIGNED
<br /> K. F. McDermott M. D. � arand Isl�n�,, Nebr. - I. �-�FO
<br /> 24a. BURIAL,CRr:MATION, 2Ib. DATE 24e. NAME OF CEME TnRY OH CHE.MA7'ORY 24d. ..00ATION (City,town,or coun y) ' (State)
<br /> REMOVAL (Specify)
<br /> Removal & Burial I MaY 6, 1950 I Q�rand Island I Grand Island N�br
<br /> DATE REC'll liY LOCAL REG. HB:GIS1'RAR'S SI(iNAT'U'RE 25. FUNERAL DIRECTOR'S SIGNA7'URE ADDRr:SS
<br /> �tav 6-1950 J• '�1• Sull3,van Geddes Funeral. Home C�ra.nd Island, Nebr.
<br /> 2�. I hereby certify I personally embalmed the body of th� deceased named hereon. �
<br /> Damon J. Nielsen License No. . 15�5
<br /> THIS CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN ORIaINAL CERTIFICATE ON FILE WITH THE STATE DEPART-
<br /> �SENT OF HEALTH, BrJREAU OF' VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br /> ( CORP� Frank D. Ryder M.D.
<br /> (S�AL) D E OR QF E A D S A E EG
<br /> LINCOLN, NEBRASKA JUN 21 1950
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