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<br /> �� �C �E��L.�.�T]E��7� ��C �]�.� �J
<br /> 21817—The Augustine Co., Countq Supplies, Grand Island, Nebr.
<br /> f'or a.nc1. resic�in; in s�id ccunty, personally came Joe W.Millsap, as agent for the o��mers,
<br /> a.nc? x�llie x. �hause, to me knoT��n to be the identical persons whose na,rnes are af°ixed to
<br /> the forP�o�n� instrument as gra.ntor and grantee, respectively, ;�nca. ackno?aledged th? same
<br /> to be their voluntar�T a et �.nc� ��eed.
<br /> v'�itnesr my hr�.n�?. <�nc� Notarial ►�ea1 the da,y a,nd ye�r last a�ove written.
<br /> �. �.��ven
<br /> ( SEAL) Notary Public
<br /> My Comr�.i s�ion ex��ires the 2� c�.ay of Ju1y, 1g46
<br /> Filed fcr record thi s ?_lst ��y of September. , 194�t, at 10:00 0 � clock A.I��J�� �
<br /> � egister of ee s
<br /> �_0_0_0-0_n_r�_n�!1_�_Q_7—(%—(��—�i—n—O—�—Ci-''�-�-�-�-�-O-Q-�-0-7-0-7-'��-�-0-0-0-0-0-0-0-0-n-�-0-0-
<br /> CERTIFICATE OF D�ATH AIJD AFF'IDAV�T
<br /> SER,A No.74 D
<br /> DEPAR'1'�;iENT OF HEALTH
<br /> Division oP Vita1 S�Ga�istics
<br /> 5TANDARD CERTIFICATE OF DEATH � 4�705
<br /> City oP Omaha, Tdebraska
<br /> COUTITY-DOt1GLAS SOCIAL SECURITY NO
<br /> ---------------------___- --------------------------------------------------------------------
<br /> I.FLACE OF DEATH: 2.USUAL RESIDENCE OF DECEA5ED;
<br /> a) Count Dou las ( a) State Nebraska (b) County
<br /> � Y �
<br /> (b} City or town OMaha Douglas
<br /> ( IP outside city or town limits,Wr�.te RURAL) ( e) City or tovrn Omaha
<br /> ( c) N�m� of hospital or institution (TP outside city or town
<br /> ( I�' not in hospital or lnstitution write street limits,write RURAL)
<br /> nurnber or Ioca�Gion) ( d) 5tree'G No.2011 Cal�.Pornia
<br /> (d) Len�th o�' stay:Sn hospital or ins�ltu�ion 32 mon�hs ( IP rural �lve location)
<br /> ( Speci�'y whe'�her ( e) IP Pore�.gn born,how lon� in
<br /> 2n '�his community 10 years U.�.A. S -------- years
<br /> Year�,months or days)
<br /> ----------------------------------- ------- - - - - -_ __ ______--------
<br /> (a FULL NAI��E Mrs.Rachel Ell.en Dutton fl2EDICAL CERTIFICATTON
<br /> j b If veteran, 2d;Da�e nP death:lt2on'�h 7-9-day 1944
<br /> name war ------------- ---- hour minute
<br /> �.Sex fem�ale S.Color or 6 (a� Single,�idoaved 21.I Hereby certi�'y that I at�ended
<br /> married, divorced I�Iarried the deceased Prom
<br /> 6 (b) N�e oP husband or wif e�-( c) Age ot' hus�and 3-2�-�+�+,1�--, to 7-9-4�,1�---;
<br /> Sidney C. Dutton or w3.fe if alive tha� I las'� sa�r her alive on 7-�-44, 19- ;
<br /> 54 yrs. and that death occured on �he date
<br /> 7.Birth date o�' dsceased 6-17-1�87 and hour �tated above Duration
<br /> (a2onth) ( Day) (Year} Immediate cause o�' death
<br /> ____________________________________________________ cerebral arterioael.eros�.s
<br /> �.AGE: Years 57 I�Zonths 0 Days 22 IP less th�.n one day Due to
<br /> ----hr.----- min. Due 'to
<br /> 9. Birthplace Glen E1dEr County,Kan�as Other eonditions coronary sclerosig
<br /> ( City, Town, or count�) ( State or Porei�n ec�untry) �pgygl�IAN
<br /> lO.Usual occup�tion Fiousewife ( Includ� regancy within 3 mor�ths
<br /> ll.Indus�ry or business of death�
<br /> � 12.N�e John t�ill iam Padget It2a,j or f indings : C erebral :`.
<br /> �{13.Birthpl.ace Iowa art�riosclerosis
<br /> ( City, town,or county) ( State or fore3�n coun'try) Underline
<br /> � 14.R�aiden nAme Rachel the cause to
<br /> � 15.Birthplace Unobta3.nable whie� death
<br /> (City, town, or county) ( State or f orei�n country) should be
<br /> 16. (a) Informant 's own signa'�ure NI3.Gs 147ar�a�et Dutton char�ed s'�a-
<br /> (b) Addres� 517 Oa��dale,Chica�o, Ills tistic�lly.
<br /> 17. (a) burail (b) Date thereo�' 7-11-4� 0�' au�o s
<br /> (Burial, cremation,or r�moved) (l�onth) (Day) (Year) 22.IP death wag due to ext nal
<br /> ( c) Place:burial or cremation Forest Lawn causes,fill in the f'ollowing:
<br /> 1�. (a) Signature of funeral direc�tor Brailey & Dorranee (a) Acciden�, euicide,or homieide
<br /> �b) Address 1�23 Cummir� 5t.OmaYia Nebr. speciPy)
<br /> 1.�. (a) 7-12-� (b) R.A.FIarmon (b) Date oP occurence
<br /> (Date received local registrar) (Regi�trar' s signature� c) Where did in,�ury occur l-----,
<br /> � ( City or '�own) (County) ( �tate)
<br /> ( d) Did in,�ury occur ln or about
<br /> home,on �ar�, in induatrial place, .
<br /> in public place ? ---___-
<br /> ( Specify type a� p���e)
<br /> Wh11e at work � --�( �) Means of
<br /> in�ury
<br /> 23. Signature Robert F.Farrell (M.�)
<br /> or other
<br /> Address 107 So.17th St
<br /> Date si�ned ,
<br /> Omaha,Nebraska
<br /> I hereby cert�.�'y�that�therabove ia a �rue and eorrect copy oP the eertificate^ofrdeath +
<br /> recorded i� the C�.ty of Oar�a.h�, County oP Douglas, State of Nebraska.
<br /> Dat�d this 21st of Ju7.y 194��. ( SEAL) R,H.Arrnon
<br /> Registrar �
<br /> 5tate oP �ebraska )
<br /> ) as Sidney C.Dutton,bein� Pire� duly sworn, on oath deposes and says
<br /> County oY Ha1Z ) that Rachel Ellen Dut�on mentioned in the Pore�;o3.ng death
<br /> cer�ificate is one and the same person as Rachel Dutton mentioned
<br /> as Grantee in a warranty deed dated April ZS'Gh 192�j to Lot� Two,Four, and Six, in Bloek Six
<br /> of �ollege Addition to We�t Lawn, in the City oP Grand I�land,Hall County,Nebraska, iri
<br /> which Edwin A.Carl et aI are �rantora and your affiant is also a �ranftee as Joint tentant
<br /> witl� the sai3 Rac.hel Dutton, said deed be3.ng recorded in Book 66 of Deeds at pa�;e 606 3.n
<br /> the of'fice oS The RPgister oP DPeds oP Hall. County,Nebraska; that �he estate of the said
<br /> Rachel Dutton terminated in said property at her death and the entire fee simple title
<br /> has vested in your affian� a8 surviving gran�ee.
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