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39.�
<br /> A�[� SC ]E�t,�L�.�T���J� �lEC ��.D� �.1
<br /> 21917—The Auguatine Co., County 8upplies, Grand Island, Nebr. .
<br /> CE�tTIFICATE OF DEATH
<br /> NEBRASKA (STATE) DEPARTMEldT CF HEALTH
<br /> Co�,y. Division of Vital St�.tistics
<br /> STANDARD CERTIFICATE OF DEATH.
<br /> DEPARTMENT OF COMMERCE
<br />, BUR�AU OF THE CENSUS Social security No. . . . . . . . . . . . . . . . State File tio. . . . . . . . . . . . .
<br /> 1. PLACE OF DEATH:
<br /> a County incoln
<br /> (b) City or to�.an �orth Platte
<br /> If outsid.e city, o .r town limits, write RU�3AL)
<br /> ( c) Name of hospital or institution� St. MarYs Hos�ital
<br /> ( f not in hospital or institution, write street
<br /> number or loca.tion)
<br /> (d) Lengtn of stay: In hospital or institution 2 weeks
<br /> In this community 3� .years
<br /> �Specify ?ahetner yrs.mos. or. days)
<br /> 2. USUAL RFSIDENCE OF DECEASED:
<br /> a State Nebra.ska b County Lincoln
<br /> � c) City or to?an North Platte
<br /> If outside city or toTn�n limits, �+Trite RURAL)
<br /> ( d) Street No. 90� East 6th St.
<br /> ( If rural give location)
<br /> ( e) If foreigh born, hoT� long in U. S.A. -------years.
<br /> 3. (a)FULL NAME Maggie J,Miller
<br /> 3(b) If veteran, name �.�aar ------
<br /> 4 Sex Female
<br /> , 5. Color or race White
<br /> 6. ta) Single, �aido?�red,married, divorced Widoi� 6. (b) Name of husband or wife William F,Miller
<br /> 6 ( c) Age of husband or �aife if alive ---- yrs.
<br /> � 7. $irth d�te of deceased ( Month) M�y (Day) 1� (Year) 1�57
<br /> �. AGE; Ye�,rs �6 Months 11 Days ?2 If less than one day ---hr ------min.
<br /> , 9 t �3il�thnl�CP Indiana
<br /> . � . (Ci�ty, town or county State or foreign co�zntry)
<br /> 10. Usual occupation Retired Hause�aife
<br /> 11. In��ustry or business - - - - - - - - -
<br /> FatY�er
<br /> � � 12 N�me Joel Freema.n
<br /> 13. Birthplace Not Known
<br /> Ci ty, to�vn, or. c ounty ( Sta.te or foreign country�
<br /> Mother
<br /> 14. M�iden name H�rriet Stout
<br /> 15. Birthplace Not Kno�Jn_
<br /> � City, to��n or county State or foreign country)
<br /> 16. �a) Informant � s o�an signature Harry F. �iller
<br /> (b� Add�ress Grant, Nebraska
<br /> 17. (a) R moval (b) '��ate thereof 4/20�4�-
<br /> Buria.l, cremation, or removal) (Month) tDay) (Year)
<br /> ( c) Pl�.ce; buria.l or crem�tion Wood �iver, Nebr.
<br /> lu. (a) Signatur. e of funeral director J, E. Cox
<br /> (b) Address North Platte, Nebr.
<br /> 19. �a) �+/19���+ (b) S.W.Thro el�wo�.�h,«.
<br /> � � Date received local regi.strar (Rggistrar' s signature)
<br /> � _ , MEDICAL C�'RTIFICATION
<br /> ?0. Date of death: Month April 17 day ---19�+4
<br /> 7 hour 15 minute A. M.
<br /> 21. I hereby certify tn�t I a.ttended tne deceased from l�tarch 30, 19�+� to April 17, 1944;
<br /> tnat I la.st saw her a.live on April 17, 194�+; and that de�tn. occured on the date and
<br /> hour stated above. � Daration �
<br /> Immediate cau se of death ( Apr. l2 ' �4.
<br /> Hypostatic P neumonia
<br /> Due to - Fr�cture of Hip Lingual Neck 3�30��j�
<br /> � Other cor,c?itions �enility
<br /> Ma,jor findin�s: PHYSICIAN
<br /> Of opAra.tions Underline tne cause to
<br /> ?al�ich death sh4'.��d ��
<br /> Of �ut�o�osy cnarged statiatically.
<br /> 22. If dea,th Taas due to ext�rnal causes, fill in the folloi�ing
<br /> �a) Acc�dent, suicide, or homicide � snecif y) -------
<br /> (b) Da.te o�' occurence
<br /> � C� �'�1P.?' .P, did in jury occur ------- --- - - - - - - - - - - - -
<br /> ( City or toT.�n) � County) ( State)
<br /> � (�) Did in,jury occur in or about home, on farm, in industrial place, in public place
<br /> ( S��ecify type of place) ----
<br /> While at �.tirork At HomP ( e) T'Ieans of in,jury -------
<br /> 23. Signature O, C.Kreymberg (M. D, or other) ------
<br /> Address 112 No. De�.aey St. Date signed �-/19/4�.
<br /> , North Pl�.tte, veb.r.
<br /> � 25. I her�by certify I pPrsonally Pm�a.lmed tile body of t:�.e deceased named 'nereon.
<br /> W.Lyle I�1cLean License No. 1652.
<br /> I, Roy Mehlmann, Deputy Local R�gistrar of North Platte, Nebrask� do hereby certify tnat
<br /> this is a true copy of the Death Certific�.te of "I�aggie J.Mi11er" as filed in the office
<br /> of Ci�y Clerk of North 1'latte, Nebraska , this 19tr1 d<�,y of April, 1944.
<br /> RoY Mehlmann
<br /> Det�u ty Lo cal RPgi s trar
<br /> ( SE�.L) & Notary Public
<br /> Filed. for rPcord this 25 day of April, 19�-4, �t 10: �+5 0 ' clock A. M. �/L�� �J� d
<br /> R�gister of Deeds ,
<br />
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