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<br /> �� ������ 1�1 �� �J � ��i� ��� V
<br /> 21817—The Augustlne Co., County 8upplies, Grand Island, Nebr.
<br /> � AFFIDAVIT
<br /> STATE OF NEBRASKA )
<br /> ) F�ank L.Spethman being Yirst duly aworn, says; That I am well
<br /> COUNTY OF HALL ) and personally aoquainted with the Easterly One-�'�iird (lj3) ot
<br /> Lot Six ( 6) �lock Fifty-three (53) Original Town,now City ot
<br /> � Grand Ieland,Nebraska,now owned by William McKinley Boquette,and '�hat S wa� well and per-
<br /> sonally aequainted wlth Millard F.Boquette,who received title to the above deacribed
<br /> gro erty by Deed, September 21,1907,and recorded in Book �3 at page 174 of the Deed Records
<br /> , �
<br /> �3 f� o � a
<br /> f 11 C unt ebra ka h n
<br /> y, s , avi g a provision oY that Deed that a building be �reet�d.upon
<br /> � t�e Eaeterly One-thlyd (1/3) ot Lot Six ( 6) Bloek Fifty-three (53) 4ri�inal Town,and to
<br /> my ovun knowledge, said building was started in the month of Ju7.y 1g0� and built and eom-
<br /> pleted in the Sprin� of 190�,and all conditions oP said Deed requiremen�e were aomplied
<br /> , with.
<br /> Further Aft'iant saith not. Frant L.B�ethman
<br /> SubBCribed in my presence and sworn to be�ore me on this llth day of December,l9�+�j.
<br /> Commission e�ires Jur�e �21,19�+7. (BEAL) Paul C.Huston
<br /> Notary Public
<br /> Filed Por record this 1� day of December,19�#�j,at 1 :�5 o'cloak P.M.
<br /> ��;,��� �
<br /> egiater of Deed�
<br /> -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-o-o-
<br /> CERTIFICATE OF DEATH
<br /> In ��: Title to North Half of Southeast Quar�er (N�SE�� of
<br /> �ec.22, Twp.10, N.Rg.11, west o� 6th P.M.
<br /> DEPT. OF COMMERCE STATE OF COLORADO
<br /> IBUREAU OF THE CENSUS STANDARp CERTIFICATE OF DEATH State File No. 6355
<br /> BUREAt� 8�` VITAL STATISTICS Registrar� s No.130 Dist.l
<br /> 1.PLACE OF DEATH:
<br /> �a) County Adams
<br /> b) City or town Fitzsimons
<br /> (c) Name of hospital or institution Fitzsimons General Hospital
<br /> (d) Length .of stay: In hospital or institution 4 mo. 12 da..
<br /> In this community ----- ----------------
<br /> 2. USUAL RESIDENCE OF DECEASED.
<br /> �a) State Colorado (b) County Denver
<br /> e) City or town Denver (If outside city or town limits, write Rural)
<br /> (d) street No. 1037 'Wi�lliams (if rural give location)
<br /> �e) If Pore��n born, how lon in U.S.A. --------years.
<br /> 3(a� FULL NAME Windolph, �rank J.
<br /> 3. (b) If veteran name war Spanish American
<br /> 3( c) 3oeial security
<br /> 14�.Sex Male
<br /> 5. Color or race �1hi'�e ,
<br /> 6 (a) single,widowed,married divorced- Married
<br /> 6. (b� Name of nusband or wiPe -----
<br /> 6. (e) Age of' riusband or wife if alive - yeara.
<br /> � 7. Birth date of deceased July 7, 1�74.
<br /> �.AGE: Years Months Days If less tha,n one day
<br /> , 70 10 5 -hr. - min.
<br /> �� Birthplace (�rand Island, Nebraska.
<br /> 10. Usual occupation Unknown
<br /> 11. Industry or business
<br /> FATF�ER 12. Nam;ae��-- Unknown
<br /> 1 . Birthplace (City town or county ) Unknown
<br /> MOT�-?ER 1�. Maiden name Unknown
<br /> 16� ) 15.Birthplace "
<br /> aInformant 1 s own signatur e H.T.Sethman, Capt. , MAC
<br /> (b) Address FitZSimons aH.Denver, Colorado.
<br /> 17�a� (Burial, cremation or removal
<br /> (b) Date thereof May 15, 19�+5
<br /> (c) Place,burial or crematlon Mt. Olivet Cemetery
<br /> Denver, Colorado.
<br /> 1�. �a) Siona�ure of furieral director Olinger,Mortuaries, Inc.
<br /> (b) Address , Denver, Colorado
<br /> 19 (a) May 21 1945 (b) Ella Houston
<br /> ME�?IC�AL rERTI�FICA�I�N �Registrar' s aignature)
<br /> 20. Date o eath Mon h ay day 12, ear 19�F5 hour � minut 30 P.M.
<br /> 21. I hereby certify that I attended �he deceased from 30 �ecember, 19�4, to 12 �ta.y 1945
<br /> that I last saw him alive on Zz r�ay 1945; and tnat death occurred on the da.te and hour
<br />' s�ated above.
<br /> Immediate cause of death Duration
<br /> Pulmonary tuberculosis 31 yrs.
<br /> Due to ----
<br /> Du e
<br /> to----
<br /> Other conditions
<br /> - Ma,jor findings PHYSICIAN
<br /> �f operations Underline the cau�e
<br /> to which death should be
<br /> �f autopsy Same as above charged statistically.
<br /> 22, I�' death was due to extern�.l causes, fill in the following.
<br /> ta� Accident, suicide, or homicidetspeciYy)
<br /> (b Date of occurrence
<br /> �c) Vlhere did in,�ury o ccur
<br />
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