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<br />' 21817—The Augustine Co., CountY Supplies, Grand Island, Nebr.
<br /> CERTIFICATE OF DEATH
<br />' NEBRASKA (��;�����.D�,'t�Fi�B��l$T -OF-H�A�.-�H
<br /> Division of Vital B�Catistics
<br />' - STANDARD CERTIFICATE OF DEATH.
<br /> D�ARTI�2ENT OF COMI��ERCE
<br /> BUREAU OF THE CENS�JS � Social Security No. . . . . . . . state File No. R10460
<br /> l. PLACE OF DEATH: �
<br /> (a) County H�.11
<br /> (b) City or town Grand- Island
<br /> ( c) Name of hospital or institution: St.Francis Hospital
<br /> (d) Length of stay: In hospital or institution 3 mo.
<br /> In this community 37 years.
<br /> 2. USUAL RESIDENCE OF DECEASED:
<br /> (a) State Nebraska (b) County Hall
<br /> ( c) City or to�an arand Island,
<br /> 4 d) Street No. 505 No. ��aldo ____
<br /> ( e) If foreign born, ho?a lon� in U. S.A. --years.
<br /> 3G�.�FT'LL NAME Hubert Presley Lawrey �
<br /> 3 (b) IP veteran, name war.
<br /> L} . Sex Male
<br /> 5. Color or race White
<br /> 6. (a) Single, widowe�,married, divorced Marri ed.
<br /> 6(b) Name o f husband or wif e Anna Mary Pahl
<br /> 6(c) A�e of husband or wif e if alive 37
<br /> 7. Birth date oP deceased Jan. ],�, 190�
<br /> �. AGE : Years 37 Months 10 Days 29 If less than one day ---hr----min. ---
<br /> 9. Birthplace Grand Island, Nebf�.
<br /> 10. Usual occupation Radio Repairman
<br /> 11. Industry or business. Radio repairing.
<br /> FATH� .
<br /> 12. ame Harry Lawrey
<br /> i3. Birthplace Letart F�,lls, Ohia.
<br /> MO��ER
<br /> �.�-'�.3�e`n name Inez Schnorf
<br /> 15. Birthplace Charleston, Illinois.
<br /> 16� Informant 's oTrun signature J. W.Lawrey
<br /> �b) Address Gra,nd Island, Nebr.
<br /> 17. (a) Burial (b) Date thereof 11-20-�5
<br /> (c) Place: burial or crem�,tion Grand Island, Nebr.
<br /> 1�. (a� signature of funeral director -Livingston-Sondermann
<br /> (b Address Grand Island, Nebr.
<br /> 19. (a) Dec. 3, a.945 (b) F. S.White (Regi�trar �s Signature)
<br /> (D�,te recorded �ocal Re�istr�.r. ) •
<br /> MEDICAL CERTIFICATION
<br /> " 20. Date of dea 1: on ov. ay 7 1945 .
<br /> 7 hour 05 minute P.M. '
<br /> 21. I hereby certify that I attended the deceased from ------ 19---, to ------, 19----�
<br /> thn,t I last saw h-- alive on -----------, 19---, anc� tn�_t death occurred on the date
<br /> and hou� stated above.
<br /> Immedi.ate cause ol death Cachexia �.ue Extensive Li��o
<br /> Osleolylic Scarcoma of Pelvic bones.
<br /> Duration 4 mos.
<br /> Other conditlona ---------
<br /> Ma,jor findings:
<br /> Of operations Bio�'ry Sh�wed:�_�,ifo Sar,.coma
<br /> 22. If death ?aas due to external causes, fill in the followin�:
<br /> (a� Accident, suicide, or homicide (specify)
<br /> (b) Date of Occurrence (NO)
<br /> � (c) �'+There did in,jury occur
<br /> (d) Did in�ury occur in or about home, on farm, in industiral place in public place
<br /> '�hile at T�rork T•qeans of in,jury
<br /> 23. Sign�ture Earle Q.Johnson M.D.
<br /> Address ------ - Date s�gnec�----
<br /> I hereby certify I personally embalmed the body of the deceased n�med hereon.
<br /> James D.Livingston License No.1�35
<br /> THIS C�TIFIES THE ABOVE TO BF A TRUE COPY OF AN ORI�INAL CERTIFICATE ON FILE ?�IITH THE
<br /> STATE DEPARTi�IEP1T OF HEALTH BUREAU OF VITAL STATISTICS, ?.�iICH IS THE LEGAL DEPOSITORY FOR
<br /> VITAL RECORDS.
<br /> (�EAL) W. S.Petty M.D.
<br /> , D RE .0 OF �F� AN A E E QR
<br /> - - LINCOLN NEBRASKA JUN 21, 19�6
<br /> Filed for record this 5 day of July, 19�+6, at 3:00 0' clock P.M. � ����� �
<br /> �_. ���-,y
<br /> egister of e�eds�
<br /> 0-0-G-0_0-0-0-0-0-0-0-0-(�-0-0-0-0-�-0-r-�-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-�-0-0-0-0-0-0-0-
<br /> AFFIDAVIT
<br /> IN RE: TITLE T� LOT ONT HUNDR�D A"�?D FIFTY-ONE '�BELMONT°
<br /> AN AD?:ITIOtJ TO TH� CITY OF GRAN� I�LA�!1D, NEBRASKA.
<br /> AFFIDAVIT 0�' IDFNTIFICATION
<br /> State of Nebraska)
<br /> • SS..
<br /> County of Hall )
<br /> John '�l.La�rrey, bein� first duly stvorn u��on his o�th, deposes and says: th�at he is a
<br /> resident of Grand Isl�nd, Ha11 County, Nebrask�, and has been such resident for more than
<br /> ten years last p ast; that he is a brother of H.P.Lawrey, one of the Grantees in that cer-
<br /> tain «arranty deed recorded in Book �1, Page 221 of the Deed Records of Hall County, Ne-
<br /> bras?�a., a.nd Hubert Presley Lawrey who �assed ataay and ��*as buried in the Grand Island
<br /> Cemetery on November 20th, �9�+5, and that affiant knows of his oThm personal knowledge
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