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<br /> ��. SC���Lt�����JS ��CC��.� �.3
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<br /> rxa eucu�ri�E co.-7606
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<br /> � aeor e Caw�c�n ��
<br /> '` In the presence ofs B
<br /> �mma Cowton ,i
<br /> ` C lgude A. Davi a Part ies of the Fir�t Par t. �:
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<br /> '�. H. Thompson ;�
<br /> Nett ie I. Thompso� ir
<br /> Parties of the Second Part, '
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<br /> State of Nebra�ka ) `
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<br /> Hall County ) On this 27 d�y of Augu�t ,1934,before me Clavde A. Davie,a Not�rq Publi�
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<br /> in and for eaid CoLmty,pereonally appear�d the above named W. H. Thompeon and Nettie I. Thompeon , ;'
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<br /> hie wife,and George Cowton a.nd �rnma Cowton,his wile,to me known to be the identical persone who �I
<br /> �aecuted the foregaing Agreement and they �everally aclrnowledged the executioa of this inetrumen�
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<br /> ; to be their voluntary act and deed for the purpo��e therein expre�sed. �i
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<br /> �itne$s my hand and officisl eeal on the day and year last above r►ritten.
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<br /> ( SEAL) C laude A. Dav i s i;
<br /> Notsry Public '`
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<br /> ' My conmission expires Feby. 3►��3?• i
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<br /> Filed for record thia 4 day of 3epte�nber ,1934 at �: 30 0� �lock A. M. k�
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<br /> Regieter oi-- Deec'� i�
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<br /> -o-c�o_o-o-o-o-o_o_o-o_o_o-o-a-o-o-o�o_o-o-o-o-o-o-o-o-o-o_o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-a-o-� ;I
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<br /> ' CERTIFIED COPY OF DEATH: ;�
<br /> �TATE OF NEBRA8KA --------------------------- �i
<br /> I. PLAC'� GF DEATH Bureau of Health-Divieion of Vital ( Do not �rrite in this epace��
<br /> County Hall 5tatietics ( 0 1739
<br /> Tormehip C�RTIFI�D COPY OF D�ATH �
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<br /> City Grgnd Island No. 1105 9treet So California (If death occured in g ho�pitsl !�
<br /> (or institution give ite NA�E ;!
<br /> (instead of etreet and number, ij
<br /> Length of resid�nce in ci�y or town r►here death occured yr, mo dg. How long in U. �. if o� ';
<br /> foreign birth�yr mo da. !;
<br /> 2. FULL NAME Samuel Ray �dington �I
<br />� ` Residence 1105 So. California gt. ,Grand Island,Nebr. ")
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<br /> P$R90PTAL AND 9'1'ATI9TICA� PARTICULAR9 MEDICAL CERTIFICATE OF D'�ATH
<br /> 3. S�X . Colar or Race . Single �Rrite the �rord l DATE OF EATH Feby 1 , 1 3 ,
<br /> ; Male �'hite Marrisd 22 I HEREBY C�RTIFY,That I attended ;,
<br /> vVidowed Msrried dece�sed fram Aug. 1 ,1931 ,to Feby 1 ,1932 �i
<br /> Divarced I laet saw him alive on JanY 1 ,1932 ,death i�
<br /> . Date of Birt mo u , da 25 !�r. ��1 _ fe said to hane occured on the de,te eteted ;�
<br /> � 7. Age Y�ars Month� D6Ys Hr8l�gortMin. d�� above,at 4:15 p. M. ;
<br /> 5 � _ _ The prin�fpa2 caus e �! death and r alat ed !
<br /> causee of importance in order of onaet were ji
<br /> . Trt�de. profes�fon ,or particular a� folloas: i�
<br /> kind of work done,as spinner , Retroperitoneal 9arcoraa Date of oneet �
<br /> eawyer ,bookkeeper ,etc. Commercial Mgr. metastatic f5rom Aug 1931 ',
<br /> ; 9. Induetry or bueinsss in whic�i U-tility Businees Kitral 1�sion faecie left !;
<br /> work �ras done,e.s silk mill , Public Utility Co lower leg ''
<br /> saw mill ,bank,etc. Sarcomatoue maases were !
<br /> 10. Date deceased last worked at 11. Tota1 time fotmd in '
<br /> this occ�p�tion (month and .� yb��)�pen�, in Contributary eauses of importance not r�lat d
<br /> year) 10/23/19�1 this occupation to principe�l cause,�; �i
<br /> 1 s g mos. 3pleen,lunas,liver�bowel & Peritoneum 12-��1
<br /> 12. Bir thplace C it y or town Koleen
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<br /> and
<br /> State or count Indi Name o� operation ��ploratory Date of 12/3/ � 1
<br /> !' 1 Nam� o Fa�t er �liza E in ton '�hst test confirmed diagnogie? Mioro�acope i�
<br /> 1 . Birthplace City or town �as ther� an auto s � �
<br /> of ( and Indie�ne 23. I deat Ra�$ ue to externa causea !
<br /> Father ( �tate or countrY (viol�nce) fill in al�so the following. '!
<br /> 1 . Maiden name of Mother Dda�r Connel. Acc ident ,suie ide,or homic ide� no Dat e o� (�
<br /> . n i r t p l a c e C i t y o r t o w n D o n� t K n�w i n�ur y , l� �
<br /> ot ( and 9Phere di� in jury occur ? l�
<br /> �i Mother 9tate or countr Indians ( Specify c�t�r' ar to�n,county,and 9tate) �I
<br /> ' 17. INF(��dAN2 Mr�. S.Ray Edington 3peoifp wheth�r in3ury Qccuxred in Industry '
<br /> � Address (3rand Island Nebr. in home,or in publiQ place �
<br /> ' 1S. Burisl,Cr�mation,or Remova� Manner o! in�ury no , ''
<br /> �� Palce Grand Ss].and,Nebr. Date 2/3/32,19 1Qature of in ur :
<br /> � 19. Undertaker 0' Loughlin-I,ivingston Co. . t�as ecease or in�ury in any way re ate �
<br /> �A,�ddreBS) (�rsnd Island,Nebr. to occupation of deceaaeA � no ;
<br /> " 20. Filed Feb. '—r,1932 H. E. C11 fford Reai�atrar _ If so,s ecify � j�
<br /> ! 8igned� Esrle G. John�on, � D. ��
<br /> �' �Address) (�rand Island,Nebr. ;
<br /> � I hereby certify that the foregoing ie a true copy o4 the certificate of death of Sa.muel Ray ��
<br /> ., �dingtcn filed with the Division of Vital 3tatistiee Bureau of Health. j`
<br /> Jean Barr et t ;e
<br /> I� ( SEAL) 9ta�te Regietrar i�
<br /> ,; Lincoln,Nebraega,Au�ust 17,19j4 , ;t
<br /> Filed for record thie 6 �day of 9eptember ,1934,8t 3:45� o�clock P. �d. �
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<br /> " Regieter of Deede �
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<br /> -o-o-a-o-o-o-o-o-o-o-o-o_o_o-o-o-o-o-o_o-o-o-o-o_o-o-o_o-o-o-o-o-o-o-o-o-o-o-o-o-o-o_o-o_o-c�o... ;!
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