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I ��� I <br /> �� ����������� ��� ��� � <br /> 21917—The Augustine Co., County Supplies, Grand Island, Nebr. . � � <br /> CERTIFICATE OF �EATH <br /> NEBP.A.SKA (STATE� DEPARTMENT OF FiEALTH <br /> DIVISION OF VITAL STATISTICS <br /> � STANDARD CERTIFICATE OF DEATH. <br /> DEPARTM^NT Or �9����ERCE <br /> BUREAU �F THE CENSt1S Social Security YJo. . . . . . . State File No. 0 ��7�+ � <br /> . . <br /> I 1. PLAC�' OF DEATH: <br /> a Coun t A�lI - <br /> � 7 y <br /> (b) City or tor,,�n Grand Island - <br /> - (IP outalde city or to�an limits, write RURAL) <br /> I ( c) Na� of' htbspital or ins�titution: <br /> 41� w.7.4th - <br /> not in osp ta�. or ins u on, �rri e s pe� num er or oca'tion) • <br /> (d) Length of. stay: In hospital or institution --- -- - <br /> In this community �F6 yrs.� <br /> - (�pecify whether yrs. mos. or days. ) <br /> 2. USUAL R�S�IDEN�E OF DEGEASED: <br /> (a) State Nebr. (b) County Hall <br /> (c) City or toi�n Grand Tsland <br /> (If outaide- city or tot�rn limits v�rite RURAL) <br /> (d) street No. Rural <br /> (�t` rural give location) <br />' (e) If fareign born, how long in U. S.A. 63 yeara. <br /> 3. (a� FULL NAME Metta Quandt <br /> I 3. (b) If vAteran _ <br /> nam e war - - - - - - - - - - <br /> 4. Sex Female <br /> 5. Color or race White <br /> 6. (a) Single,widowed m�.rried, divoreed Widow <br /> 6. (�)Name of husb�nd or wife Albert Quandt <br /> 6. (e) Age of husband or wife if alive ------yrs <br /> �. Birth date of cleeeased Nov. 26 1� � <br /> (Month� (Day} �Y�ar) <br /> F�. A(�E: Years 65,Mon�hs 1� D�.ys ---- If less tnan one day ---hr. ----min. , <br /> 9. Birthplaee t C3.ty, tqwr� ar �ounty) Hanover ( State or forei�n country) t�ermany <br /> 10. Usual occupa.tion At Home. <br /> 11. Inc�ustry or business <br /> Fa.ther <br /> 12. Na.me CZaus Bors t el�.nn <br /> l�. Birthplace (City, town or county�------ ( �t.Pte or foreign country) Germany <br /> Mo th er <br /> 1�4. Maiden name No.Rec. <br /> 1 .Birth�lace (�City town or county) --- (State os� forei�n country) No Rec. <br /> l�. (a) InYorman'�' s own signature Walter Quandt <br /> (b) (�rand Island, Nebr. <br /> 17.a(Burial, cremation or removal Bur1a1 <br /> (b) Date thereof Sept. 2 , �1 4 . <br /> (Month)�Day� (Year) ., <br /> (c) Place: burial or crer�ation: Wiegert Cemetery,Ha12 �v. Nebr. <br /> 1�. (a) Signature of funeral director Geddes Fun.Home <br /> (b) Address Grand Island, Nebr. ` � <br /> 19. (a) Date recorded lacal registr�.r Oct. 5, 19�5 <br /> (b) C. S.White (Re�is�rar 's signature) <br /> MEDI��.L CERTIFICATION " <br /> 20. Date o�' death: Month Sept. day 26 19�+�-. <br /> hour 1, minut e 30 A.M. <br /> 21. I hereby certify that I a.ttended the deceased from April 2�4, 19�4 to Sept.26, 194�F <br /> that I last sa�r her alive on Sept. 25, 19�1-; and that death occured on the date and <br /> hour stated above <br /> Immedia'te cause of death Lobar Pneumonia � Duration 2 weeks. <br /> Due to ---�----- <br /> Due to = ----- <br /> �ther conaitions (Include pre*nancy T�ithin 3 months of daath) <br /> Ma,��r findings <br /> Of operations ------------- EYS?CIAN -Under2ine the eause to which death <br /> Of autopsy --------•---- should be charged sta'Cistically. <br /> 22. If death ��aas due to external causes, Pill in the following: • <br /> (a) Aecident, suic3de, or ham2cide ( specify) - <br /> (b) Date of occur�nae - - - - - - - - - <br /> (c� Where did in�ury occur ------------------.._---------- <br /> (City or town) ( County ) (State) <br /> (d) Did in;�ury occur in or about home, on farm, in indus�rial place, in public place ----- <br /> (Specify type of place) <br /> While at work <br /> ( e) Means of in,jury <br /> 23. signature Wilr�er B.MeGrath (M.D. o�+-s�l�e� ) • <br /> Address Grand Island, Nebr. Date signed 9/26/�+�+ <br /> TO BE ACCOMPLISHED WHEN BODY IS ET�BALMED. <br /> I hereby certify I perscrnally er�balmed the body of the deceased named hereon. <br /> W.G.aeddes <br /> License No. 1315 <br /> T�iIS CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN �RIGIAIAL CERTIF'ZCATE ON FILE taITH THE <br /> DIVISION OF VITAL STATISTICS STATE DEPAR.TMENT OF HEALTH, 'aJHICH IS THE LE(�.AL DEPOSITORY <br /> FOR SAME. (SEAL) <br /> C.A.Selb M.D. <br /> E I <br /> LINCOLN, N�BRA3KA May 15, 1945 <br /> Filed fo r record this l� d�y of May, �g�+5, at 9;�+5 0� cloek A.M. � Of���� (��� <br /> L ` <br /> Register af Deeds <br /> 0-0-�-0-0-0-Q=0-�-0-0-0-0-0-0-0-�-0-0-0-0-�-0-0-�-0-0-0-0-0-�-0-0-0-0-�-0-0-0-0-0-0-0-0-0-0 <br />