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<br /> PHS-798 (VS) Reu. 4-48. Federal Security Aqency, Public Healtk Service. (Containing 475 printed words}
<br /> NO. 188-THE�UGUSTINE C0.GR11ND ISL�ND.NEBR.
<br /> l 1'A?E Of' 1J£.88A5t�A Filed in ihe o,�ce of ihe Register of Deeds the 24 dab
<br /> CERTIFICATE OF DEATH � ��°"� Hall � oj March 1952 , and recorded in Miscellaneous
<br /> � Record No. ��Qtt on Page 214 ,
<br /> OF � • G���
<br /> i c(""a'
<br /> Regisier of Deeds��C�Fkdc.
<br /> t
<br /> George Bauer i
<br /> I
<br /> App[ies to R. E. Description By Deputy.
<br /> �:� ��
<br /> - - - - - - - - - - - - - - - - - - - - - -'- -uiz:_F. 132 ft_of Bl. 17 KcehlerSuh. T - - - - - - - - - - - - - - -
<br /> STATE OF NEBRASKA
<br /> DEPARTMENT OF HEALTH
<br /> Birth No. 126 Bureau of Vital Statistica State File No. 51-004911
<br /> I7, P CE OF DEA N 2. USUA RESID N (W ere ecease ive . If mst�tution:'resi ence e ore a m�ssion).
<br /> a. COUNTY Hi3,l.I a. ST.1TE Nebraska b. COUNTY Hall
<br /> . CITOY� (If outside corporate limits,write Rural). I c. LENGTH OF STAY(in this place) c. CITOY� (If outside corporate limits,write RURAL)
<br /> TOWN Grand Island TOWN Grand Island
<br /> d. FULL NAME OF (If not in hospital or institution,give street address or location) d. STREET (If rural,give location)
<br /> HOSPITAL OR
<br /> ADDRESS
<br /> INSTITUTION St. Fra.ncis Hosp. 116 East Bismark
<br /> AME O a. bust) . ( � e) c. ( ast) 4. OF Month) Way) (Year/
<br /> � DECEASED
<br /> Geor e Bauer ! DEATH 5 3 51
<br /> (Typ�o�Print) g
<br /> 6. SEX 6. GOLOR 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 /> Male I White I Married 6-4-1888 62 I �
<br /> t0a. USUAL OCCUPATION (Give kind ot work done during 70b. KINll OF BUSINESS OR 17. BIRTH- (City,town or county)(State or foreign 72. CITI'LEN OF WHAT
<br /> most of orking Iife,,evPn if retired) INDUSTRY PLAGE country) COUNTRY7
<br /> �ustod2an 7i0 ! Post Office I Frank, Russia l U. S. A.
<br /> 13. FATHBR'S NAME 74a. MOTHER'S MAIDEN NAME 14b. NAME OF HUSBAND OR WIFE
<br /> George Bauer I Marie Frick I Mar�y Uhrich Bauer
<br /> 16. WAS DECEASED EVER IN U.S.ARMED FORCES`l 16. SOCIAL SECURITY No. 7T. INFORMAN 5 NAME or Signature&Address
<br /> (Yes,no,or unknown) I (If yes,�ve war or dates of service) I
<br /> No '
<br /> 18. CAUSE OF DF.ATH MEDICAL CERTIFICATION �re!srvai Bstwssn Onset
<br /> Entcr only one cause per aod Dsath
<br /> line for (a), (b),and(c) �, DISEASE OR CONDITION
<br /> DIRECTLY LEADING TO DEATH• �a� Hypertensive heart disease _ _pnknown
<br /> 'This doss not mean 4h• ANT�CEDENT CAUSES
<br /> mods of dyfny, such as
<br /> � hsar! fallure, asthenla, . �
<br /> �lc. It moans tl�s dis- DUE TO (b) -
<br /> ease,Jn)u�y, o�compli-
<br /> eation whicb caused Mo�bid eondittons, if any, ylvinp
<br /> dsatb. ��ise to the above cause (a)statinp
<br /> the unde�lyin9 eauas last. DUE TO (c) ----
<br /> 11. OTHER SIGNIFICANT COTVDITIONS
<br /> Conditions cont�ibutiny to the dealh but�ct
<br /> �elsted to ths diseaas o��o�a�t�o��a�:���a.atti. Cerebrovascular hemorrha�e Uremia
<br /> 19a. DATE OF OPERA- I 19b. MAJOR FINDINGS OF OYERATION I 20. AUT�PSYI
<br /> TION Yey p No �
<br /> 21a. ACCIDENT (Specify) I 21b. PLACE OF INJURY (e.g.,in or about home,farm. I 21a (CITY OR TOWN) (CUUNTY) (STATE)
<br /> SUICIDE factory,street,ofTice bldg.,etcJ (If rural area>write RURAL)
<br /> HOMICIDE ,:
<br /> 21d. TIME (Month) (Day) (Year) (Hour) 21s. INJURY OCCURR�D 21f. HOW DID INJURY OCCUR? --��•�
<br /> OF While at Work ❑ "
<br /> INJURY m• Not While at Work ❑
<br /> 22. 1 hereby c��tlfy that I attend�d 4h• decsased f�om- �-22 , 79�� !o �S-� -, 79�_,.th�t 1 last s:aw th•
<br /> deeeased aliw on 5°2 , 7g 5� ,and that doalh oeeu�rod at 4:�� Am.,from!h�eauses and on tbs date statsd above.
<br /> 23a. SIGNA7'URh (Degree or title) 23b. ADDRESS 23e. DATE SIC:NED
<br /> Loren E Imes M. D. I Grand Island Nebr. I 5-3-51
<br /> 24a. BURIAL,I:R�MATION, 24b. DATE 24e. NAME OF CEMEI'nRY OI� GRB.MATO1tY 24d. ..00ATION (City,town,or county) (State)
<br /> REMOVAL (Specify)
<br /> Burial I 5-7-51 I Grand Island � Grand Island, Ne�raska
<br /> DATE REC'll 13Y LOCAL REG. REC;IS7'RAR'S SI(:NATURE 2b. FUNERAL DIRECTOR'S SIGNAI'URE ADDRESS
<br /> May 11. 1951 _ ______ F. S. White LivitL4ton-Sondermann Grand Island� Nebraska
<br /> 25. I hereby certify I personally embalmed the body of the dPCeased named hereon.
<br /> ,james D. Li�ingston License No. 1835
<br /> THIS CERTIFIES THE ABOVE TO Bl� A TRUE COPY OF AN ORIGINAL CERTIFICATE ON FILE WITH THF. STATE DEPARTMENT OF HEALTH,
<br /> BUREAU OF VITAL STATISTICS, WHICH IS THF LEGAL DF,POSITORY FOR VITAL RECORDS.
<br /> (SFAL) C. L. Chism
<br /> DIRECTOR OF VTTAL STATTSTICS AND ASSISTANT
<br /> STATE REGISTRAB OF LINCOLN, NEBRASKA.
<br /> Issued March 10, 1952
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