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��� <br /> 1�JL� ����Jld� 1�1 �� �.J � ��� ��� 'd.J <br /> 21917—The Augustlne Co., County SuPplies, Grand Island, Nebr. � <br /> This is to certify that, if bearing prenumbered sta.mp, and seal, of' the California <br /> State De��.rtment of Public Health, this is a true copy of an orig�nal certif icate on fi1.e <br /> in this off ice. <br /> Marie B. 5tringer, <br /> Sacramento, California, Dated: October 26, 19�+�-� Registra.r or Vital Statistics <br /> Certification Fee Paid - - - �1. 00 <br /> ��7�+5 <br /> Ca1.if'ornia State ( SEAL) <br /> Departrnent of Health <br /> Filed for record �his 3� day of October, l�ll-� at 10 :C0 o ' clock A. M. <br /> �Jl�-.�a-�d��, <br /> Register of Deeds <br /> a-�-o-o-o-o-o-�-o-o-o-o-�-�-o-o--o-o-o-c-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o--o-o-a-o-o-o-o-o-o <br /> CERTIFICATE OF DEATH � <br /> DEPARTMENT OF HEALTH <br /> Divis�.on of Vita1 St��.tis�ics <br /> De;�artment o�' Commerce STANDARD CERTIFTCATE OF DEATH State File No. <br /> Bureau of Censias State of Nebraska <br /> .l. Pla.ce of Birth <br /> (a) County Adams <br /> (b) City or town Hastines <br /> If' out5ide city or town limits write RURAL <br /> (c) Na.me of hospital or institution 1002 West 7th St. <br /> If not in hospital or instituti�n write street number or location <br /> ( d) Len�th of stay--in hos��ital or �nstitution <br /> Specify whe�her <br /> In �his community 53 years <br /> year�, montns, days <br /> 2. Usu�l Residence of Deceased <br /> (a) SLate Nebraska (b) County Adams <br /> ( c) City or town Hastings <br /> Tf ou�side city or town limits write RURAL <br /> (d) Street No. 1002 West 7th St. <br /> If rural give location <br /> ( e) If foreign born, ho�� Iont; in U. S. Years <br /> j. (a) Fu11 Name MRS. SUSAN RAPP <br /> (b) If veteran name war <br /> �-. Sex Ferna�.e � � <br /> �. Co�o,� r}�� �ace VT�lite <br /> �, (�,} Sir.gle, widowed, married, divorced - Widoti��ed <br /> (b) Name of husb�,nc� or wife W�lliam <br /> � ( c, A�e of husband or wif e, if alive yrs. <br /> + r S temb r 1� 1� <br /> 7. Birth da�e cl deceased ep e 7, 57 <br /> Month Day Year <br /> �. Age Years A4onths Day� If lesa than one day Hrs. Min. <br /> �4 o z3 <br /> 9. Birthplace Columbia County, Penn <br /> City, �own or county State or foreign country <br /> I0. Usual occupation Home <br /> 11. Industry or business Home-making <br /> � 12. Name Thomas L�.uderbaugh <br /> � <br /> � <br /> 4 13. Birtr�place Penn <br /> Cit�r, town or county State or foreign country <br /> � <br /> �� 1.��. Maiden n«me Eli�abeth H�rtman <br /> j <br /> �� 1�. Birthpla.ce Penn <br /> Ci�y, toUrn or county S�ate or foreign co�a.ntry <br /> 16. (a) Tnforrnant � s oTfm signature Miss Tacy Rapp <br /> (b) Address Has'tings, Nebraska <br /> 17. (a) Burial (b) Date thereof Oct: g, Z9?+l <br /> Burial, cremation, removal bsonth Day Yezr <br /> ( c) Place --Burial or cremation Parkview <br /> l�. ( �) Signature of funeral director Hastings, Nebraska <br /> (b) A�dress Voll�nds Funeral Home <br /> 1G. ( a) 10/31/�-1 (b) Edward L. Dier <br /> Date receive�. loca.l Re�istrar Registrar ' � S��nature <br /> �•2EDICAL CERTiFICATIO�T <br /> r0. Da�e of death--Nionth Oct. day 5 1�1I-1 1 hour �0 minute <br /> P.M. <br /> 21. Z herPp�� certi�'y that I a�tencled the deceased from Dec. l�- 1940 to Oct. 9, l;�-1, <br /> that I last s�.w her aliz�e on Oct. 9, 19�-1, anci that death occurred on the date and <br /> hour st�ted �bove. Imrri�c�iate cause of death Cerebr�.l Hemorrha�e. Due to <br />