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<br /> PHS-798 (VS) Reu. 4-48. Federal Security Agency, Public Health Seruice. (Containing 475 printed words}
<br /> NO. 168-TNEAUGUSTINECO.GRAKDISLAND.NEBI1. � � �
<br /> I ?A?g Of tJ£88A5t�A
<br /> ��rr Filed in the ofj'ice of ihe Regisier of Deeds ihe 26 day
<br /> CERTIFICATE OF DEATH � ��'00 Hall o.f March lsgl , and recorded in Miscellaneous
<br /> � Record No. Q on Paqe 206 9
<br /> OF � �w �o�.�.
<br /> �
<br /> � Reqister of Deeds-E�[�k.
<br /> Elizabeth Ann Hettrich i
<br /> � Appties fo R. E. Descripiiore By Depufy.
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<br /> - - - - - - - - - - - - - - - - - - - - - -'- -aiz:- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
<br /> STATE OF NEBRASKA
<br /> DEPARTMENT OF HEALTH
<br /> Birth No. 126 Buresu of Vital Statiatics State File No. 49-010915
<br /> 1. PLA E OF D TH 2. USUA RESID N E (W ere decease �ve . f msUtution: resi ence e ore a m�ssion).
<br /> a. COUNTY Hall H-36Z a. ST.1TE NebY• b. COUNTY Merrick
<br /> b�C�OR �If outside corporate limits,write Rural). c. LENGTH OF STAY(in this place) c. CI�Y� (If outaide corporete limits,write RURAL) ,
<br /> TOWN Grand Island I 2 hours TOWN Grand Island
<br /> d. FULL NAME OF (If not in hospital or inst�tution,g�ve street address or►ocaUon) d. STREET (If rural,give location)
<br /> HOSPITAL OR ADDRESS
<br /> INSTITUTION St Francis Heanital � 12�.7 we8t ZSt St.�
<br /> �,NT OF a. Hiret) . (Mi�e) c. st) 4. ODF Month) (llay) (Year�
<br /> DECEASED DEATH
<br /> cTVp.o.P�int) Elizabeth A n Nettrich Nov. 9_, 1949
<br /> b. SEX 6. COLOR OR RACE 7. MARRIhD,NEVER MARRIED, 8. DATE OF $1RTH 9. Age(In yrs. If Under 1 Year If Under 24 Hra.
<br /> WIDOWED,DIVORCED S ecif ) last birthda ) Mos. Da s Hours I Min.
<br /> � P Y Y Y
<br /> female I white I married Tulv 18, 1870 79 3 I 21
<br /> 10a. USUAL OCCUPATION (Give land of work done dunng I 10b. KINll OF BUSINEJS OR 77. RT - (Ctty,town or county)(State or foreign 72. CITILEN OF WHAT
<br /> most of working]ife,even if retired) INDUSTRY PLACE country) COUNTRYY
<br /> At home � I McGregor� Iowa U.S.A.
<br /> 73. FATHER'S NAME I 14a. MOTHER'S MAIDEN NAME ( 74b. NAME OF HUSBAND OR WIFE
<br /> Toh N m�nn Anne Naun�ann_Raithel (Jtto 0_ Hettrich
<br /> 16. WAS ECEASED EVER IN U.S.ARMED FORCESY 16. SOCIAL SECURITY No. 17. INFORMANT'S NAME or Signature&Address
<br /> (Ycs,no,or unknown) � (If yes,give war or datea of service) I
<br /> 78. CAUSE OF DEATH MEDICAL CERTIFICATION Ire`ewal Betwesn Onset
<br /> Enter only one cause per and Dsath
<br /> line for(a), (b),and(c) �, DISEASE OR CONDITION
<br /> DIRECTLY LEADING TO DEATH• � ACIItC Ceronterv �CCl.l1S1�II �hrs
<br /> (a)
<br /> "This do�s not mean tA• ANT�CEDENT CAUSES
<br /> mods oi dyinp, sueh as
<br /> hsart faflu�s, asthenla, Art .r�al e�l_erocic _20 rs
<br /> �te. I! m�s�ns !hs dis- DUE TO (b) p
<br /> ease, injury, o� eompli- . . � �
<br /> eation whleh caussd Mo�bid eonditions, Ii any, pivinp
<br /> �� � dsa4b. � rise to�4he abovs esuse(a) statlnp .
<br /> � � . � � �. the unde�tyiny cause last. DUE TO (c) __-__
<br /> 11. OTHER SIGNIFICANT CONDITIONS
<br /> Condttions cont�ibutinp to ths dsath but nct
<br /> � �elated to the dtseass o�conditton causinp d�ath. �
<br /> 19a. DATE OF OPERA- I 19b. MAJOR FINDINGS OF OYERATION I 20. AUTOPSY`l
<br /> TION
<br /> Yes ❑ No Q
<br /> 27a. ACCIDENT _ (Specify) I 27b. PLACE QF INJURY (e.g.,in or about home,farm. 21e. (CITY OR TOWN) (GOUNTY) (STA1'E)
<br /> SUICIDE factory,street,ofE'ice bldg.,etcJ (Ir rural area,write RURAL)
<br /> HOMICIDE ,�� �o
<br /> 21d. TIME (Month) (D=y) (Year) (Hour) I 21e. INNRY OCCURR,ED __ I 27f. HOW DID INJURY OCCUR?
<br /> OF While at Work �
<br /> INJURY m• Not While at Work ❑ ��
<br /> 22. I hs�eby e�rtHy lhat 1 attsnd�d�h��scs:+s�d f�om ���9 - - - , 19�, to i1�9 -, 19�Z_, that 1 las!s:sw th�
<br /> dsceased alivs on �' , 19 , and tha!death ooeurrod at 6 Aim.,t�om ths eauses and on th�dats atatsd above.
<br /> 23a. SIGNATURh (Degree or title) 23b. ADDRESS 23e. DATE SIC:NED
<br /> W D McGrath M D I Grand Island. Nebr. I 11-9-49
<br /> 24a. BURIAL,GREMATION, I 24b. DATE 21e. NAME OF CEME'TERY OR CHBMA7'ORY 24d. a.00ATION (City,town,or county) (State)
<br /> REMOVAL (Specity)
<br /> Burial :- ° � '" ' Nov 71 �1q I Palmer Palmer, Nebr.
<br /> DATE RF'C'U 13Y LOCAL RF I REU1S7'RAR'�SI NATURE I 26. FUNEHAL DIRECTOR'S SIGNA7'URE ADDRESS
<br /> NOV 15� 1949 F_ S. White Lee E. Nichalas Palmer, Nebr.
<br /> Lee E. Nicholas License No. 1211
<br /> THIS CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN ORIGIN�II,, C�RTI�T��1'i'�� pN. �'ILE.WI'��I 'TH� 5�'ATE'�AR�'ME�i1'�4F HEALTH,
<br /> BIIREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEP4SITORY FOR VITAL RECORDS. .
<br /> (SEAL) Frank D. Ryder M.D.
<br /> DIRECTOR OF HEALTH AND STATE REGISTRAR LINCOLAT, NEBRASKA FEB 13, 1951
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