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<br /> 21917—The Augustine Co., County 8upplies, Grand Island, Nebr.
<br /> aF�z�avzT
<br /> STATE OF NEBRASY.A ) SS. AFFIDAVIT
<br /> COU:�1�'Y 0�' HALL )
<br /> I, Ludwig Sondermann, being first c�uly sworn, on my oath depose anc� say that I well
<br /> �'*m ' S1T S ti"i1 .S �7 $ },' C�.
<br /> ns durin� his lifetime ana well kno Ern�a Hargen , � o wa i �.ife, an
<br /> knew Reimer Har�e � 1 �
<br /> know of my oti�m personal knowledge th�t they �ere the DT�ners�of the East Half (E�) o� Lot
<br /> n a l B l o c k E i h t � i n K e r n o h a n & e c k e r s A d.d i t i o n i n t h e C i t y o f G r a n d
<br /> Five in Fraetio � �
<br /> �5) �
<br /> Isl�,nc�, Hu.11 County, Nebraska., the ti tle to w iz ic h prem ises t hey he l d as �jo in t tenan ts w i t h
<br /> ri�ht of survivorship; that I axn a duly licensed and practicing embalmer in Grand Island,
<br /> Nebras�ca, ��nd have been such for more than twenty years last past, that I have known the
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<br /> 2 s st st nd kn w s id R imer ar ns
<br /> state for more than 0 ear la a a e a e e
<br />� v -d s rib d r al e p
<br /> abo e e c e e Y g
<br />' and sai�. Eanma Hargens, his wife, for more than five years last past; I further positively
<br /> know ��la.t said Reimer Hargens above �sescribed died at C€rand Island, Nebraska, on July 25,
<br /> 19�-6, a.nd tliat I personally had charge of the embalming of his body and knoUr him to have
<br /> c�ied as hereinbefore sta'�ed.
<br /> Furt�ler affiant saith not.
<br /> Ludwi g Sondermann
<br /> �ubscribed in �ny presence anu sworn to before me this lst d.a,y of Au�ust, Zg4b.
<br /> (SEAL) Herbert F.Ma er
<br /> Cor�mission ext�ires 2�Ia.y 17, 1950 �atary�'6i�ic`—`�
<br /> Filed for recor�.� this lst day o� August, 1�46, at 11:C0 o � clock A.M. , �
<br /> Aeg ster of eed
<br /> 0-0-0-�-0-0-0-0-0-0-0-:)-,,._.,-0-0-0-0-0-0-�-0-��-G-��-O-G-��-�-'�-0-�-0-0-�-C-0-0-0-0-0-0-C-0-G-
<br /> CERTIFICATE �F DEATH
<br /> NE&RASKA (STATE) DEPARTg2ETJT OF HEALTFi
<br /> Division of Vital Statisties
<br /> , STANDARD CLRTIF'ICATE OP DEATH
<br /> DEPARTt�E��,T OF C�:��S�CE
<br /> BUR.EAU OF Tt�E C�`��US Social Security No. ------ St�,te File No. P 9951
<br /> 1. PLACE 0�' DEATH
<br /> (a) County H�11
<br /> (b) CitS* or toT�.m Grand Isl��nc'�
<br /> c) Name of lzos��ital o-r institution: St. Francis Hospital .
<br /> d) Len�th of �t�.y: in nosy�it�.l or institution 10 days
<br /> In �his conr.lunity �0 yeaxs
<br /> 2. USUAL RESID�,"`10E OF DECEASED:
<br /> �a) State PJebr. (b) County Merrick
<br /> �c) City or toT�un Palmer
<br /> (d) S�reet No.
<br /> (e) Iz" forei�n born, how lon; in U. S. A. --------years.
<br /> 3 (a) FULL I�.��i� Alfred Nicholas
<br /> 3. (b) If veteran, nazne ti�sar ----------
<br /> Z�. S e x M
<br /> 5. Color or race ti°1
<br /> 6 (a) Sin�;l e, �•�idotaed,marri ed, divor eed- Ma,rri ed
<br /> 6 (�) Name of h�.asband or ti�ife Flora Nicholas
<br /> 6 (c) Age of hvsband or �:�ifi e, if alive 66
<br /> 7. Birth date of deceased (P�Ionth) Sept. (Day) 21 (Year} I$67
<br /> �. AGE: Years 76 2�lontYia 0 Days 7
<br /> 9. Birt'r��l�,ce P•Zineral Point, ��disconsin
<br /> 10. Usual occupation Retired farmer
<br /> 11. I�ZCi.ustr;r or business --------
<br /> Father
<br /> 12. ame exander S. Nichol.s
<br /> 13. Birthplace Clevelanc�, Ohio.
<br /> I�Io th.ei�
<br /> l�. iaen n�r�e �alin�, Burge •
<br /> 15. Birt�iplace Corn-aall, En�land
<br /> 16. (a) In�c�rmant 's o�m si;na_ture Rosa Ansdale
<br /> (b) Adc'�ress Pa..lmer, Nebr.
<br /> 17. (a) Buri�1
<br /> (Buri�zl, crem��tion or r-rnov�l)
<br /> (b) Date tr_erec�' � Oct. 7, 1943
<br /> c) P1�.ce: buri�,l or cremation P�lmer, T��ebr.
<br /> l�. a) �i��nature oi funeral director Lee E. �d3,�h�la_s_
<br /> (b) Address Palmer, P1ebr.
<br /> 19. (a) �ate received local re�istr�.r. Oct. �`, 1943
<br /> ('�) F. S.'����te {Re�istrar 's Signat�are) .
<br /> 2•4EDICAL CERTIFI CATION
<br /> 20. Date oF �eath: P�Ionth October 4 da�T, 1g�+3
<br /> hour 20 �minute P.��T.
<br /> 21. T Yiereb;� certify tn�,� I attenc�e�� �he deceased from Sep. 20, 19�-3 �o �et. L, lgj�3
<br /> ti�<�_t I l�.st sny ��ir� �,live on Oet. '�, 19�-3 anc' t�_ai, cle�.th oeeurecl �n the da.�e �ncl
<br /> hour statea above. '
<br /> I�:�edi�.�e c�use o� «eath Ps;�cleoses 137A
<br /> Due �o
<br /> Other conditions Hyper����osta,be ,
<br /> � P�����jor fincin�s �
<br /> Of o?�eration H;n�er}�rostabe
<br /> Of a�?�'i+OT:JS�j' nor�e "
<br /> 22. If de��th ��ras c�ue to external ea.uses, fill in tne follo��ring
<br /> . .„ w. . _ _� _
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