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<br /> 21817—The Augustine Co., County Suppliea, Grand Island, Nebr.
<br /> 1�. (a) Signature of funeral director Gec�des Funeral �ome
<br />' (b) Address Grand Island, Nebr.
<br /> 19. (a) Au . 6 1 4 (b) F. S. Ulhite, (Registrar' s signature)
<br /> a�e received local registrar
<br /> MEDICAL CERTIFICATEI�N
<br /> 20. Date of death: Month Aug. day 3 19�+5
<br /> 12 hour 15 min. A.M.
<br /> 21. I hereby certify �h�.t I attended the decea.sed from Aug. 3, �9�-5 to Aug. 3, i9�+5
<br /> that I last say h�m alive on Au�. 3, 1945 and trsat death occurred on the date and
<br /> hour stated above. Duratiorl
<br /> Immediate cause of death Coronary Thrombosis 2 days
<br /> Due to'
<br /> Due to � Ph'YSICIAN Underline the cause to �ahich
<br /> �ther conditions � death should be charged statistically.
<br /> Ma,j or f indings
<br /> Of operations
<br /> � Of autopsy
<br /> 22. If clea�h was due to external causes, fill in the following:
<br /> (a) Accident, suicide, or homicide �speciYy)
<br /> (b1 Date of oecurence
<br /> ( c) ��h.ere did in,jury occur City or town County 3tate
<br /> (da Did in,jury occur in or about home, on Pa.rm, in industrial place, in public place
<br /> S_p ecify type of plaoe
<br /> ti�hile at work �e) Means of in,jury
<br />! 23. Signature W�H.Hombach (M. D. or o ther)
<br /> Address Grand Islanc�, Nebr. Date s�.gned �/3/45
<br /> . " TO BE ACCOMPLISHED Y�1HEN BODY IS ENiBALMED
<br /> ��. I hereby cert3.fy i personally embalmed the body of the deceased named hereon.
<br /> W.G.Geddes
<br /> License No. 1315
<br /> THIS CERTIFIES THE ABOVE TO BE A TRUE COPY OA AN ORIGINAL CERTIFICATE FILE T�TITH THE STATE
<br /> DEPAFTMENT OF HEALTH,BUREAU OF VITAL STATISTICS, ?�dHICH SS THE LEGAL DEPOSITORY FOR VITAL
<br /> RECORDS.
<br /> C.A.Selby, M. D.
<br /> (CORP) DIRECTOR OF HEALTh AND BURE�U OF VITAL
<br /> (SEAL) l3TATI�TICS,DecCO2�' i�4RASKA.
<br /> Filed for record this 16 day of January, 19�+6, at 9:00 0 � clock A. M. �i�� �}
<br /> �l/-�-�
<br /> egister of ee s
<br /> o-o-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-c-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-
<br /> REVOCATION QF POWER OF ATTRONEY �
<br /> - Jan.16,1g�F6
<br /> I revoke all rights oY Power of Attorney that I give my wiPe Mrs.Maxine J.Bunner. -
<br /> Hugh L.Bunner
<br /> Sworn to and aubscribed bePore me this the 16th day of J anuary,19�6.
<br /> (SEAL) G.P.LaBa�re
<br /> J.P. & Ex Of'f'icio
<br /> My Commission Expires Jan. ,lst„19� Notary Publ.ic
<br /> Filed for record thia 19 day of January,l��6,at � o 'cloek A.M. �
<br /> �ti��� �
<br /> r
<br /> Reglster ot Deeds
<br /> -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-o-o-o-o-o-o-o-o-o-o-o-o-o-
<br /> AFFIDAVIT
<br /> STATE OF NEBRASKA ss �
<br /> COLTNTY OF HO�+TAR� AFFIDAVIT
<br /> TO ��-IOM IT MAY CONCERN: In re� Lot One �1� , Block Ten (10) , in Boggs & Hill �s
<br /> Addition to the City of Grand Island, Nebraska.
<br /> I, Harry L.Lin�ford, beir�g first duly sworn, upon oath, depose and state:
<br /> That I not�r reside at St.Paul, in Howard County, Nebraska, and have continuously resided
<br /> in said County for over �-0 years; that I am well and person�_lly aequainted with mar�y of the
<br /> people t�no have resided in said County during the period of my residenee therein; tha.t I
<br /> am now the duly elected, qualified and acting Clerk of the District Coux�t of Howard County,
<br /> Nebraska.
<br /> Th�-t I �aas well ar�d personall acquainted with one James P.Larson at all times between
<br /> November 25, 1911, and October 1�, �913; t�iat I am informed that the sa�-d James P.L�rson
<br /> acquired title to the above aescribed real estate on March 5, i913, and re-conveyed the
<br /> same on Detober 1�, 1913; that tne said James P.Larson and wif'e were formerly residents
<br /> of Dannebrog, Howard County, Nebraska, �d were divoreed in 1911; that as Clerk of the
<br /> District Court of said County I have tne custody of all tne records of said Court, an�.
<br /> that a search tnereof revea,ls that sa.id decree o� divor ce was entered of record tnerein
<br /> on November 25, 1911; that to the best of my knowledge and belief the said Jam es P.Larson
<br /> did not remarry between said dates of November 25, 1911 and October 1�-, 1913, and t�ras on
<br /> said latter date a single man.
<br /> That the said James P.Laxson was also known as James P.Larsen, but that the said James
<br /> P.Larson and James P.Larsen are one �.nd the same person despite the discrepancy in the
<br /> spellin� of said name. �
<br /> Harry L.Ling�ord
<br /> Subscribed in my presence and sworn to before me this 21st day of January, 1946.
<br /> Cyril P.Shaughnessy
<br /> (SEAL) Notary Public
<br /> My commis sion expires May 7, 19�-6 , ��)
<br /> J 4 t 10:00 0 � clo ck A.M. �l/
<br /> Filed fbr rec�r� this 22 �ay �f anuary, 1' 6, a -�-�-�-� -�-�-��
<br /> Register of Deeds
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