|
���
<br /> 1�11� �� J�-�JLe 1L.e� 1 V JLe� �.J � ��`� �JL�I� �,J
<br /> 21817—The Auguatine Co., County 8upplies, Grand Island, Nebr.
<br /> i
<br />', 5 a. If married, �ridotiTed or divorced _ '
<br /> HtTSBAND of ---------- or ti�fif e of Srving James Doan �
<br /> b. DATE OF BIRTH mo. Aug. (dayr} 4 (year 1880 '
<br /> 7 . Years o2, Months 10, Days 22, If less than 1 day Hrs.---- Min.---- �
<br /> OCCUPATION
<br /> 8. Trade, profession or ����.rticula,r kind of wor� don�,: as s�inner, sawyer, bookkeeper, etc.
<br /> Housewif e.
<br /> 9. Tndustry or business,in which work was done as silk mi11, sat�r mill, bank, ete. Home.
<br /> 10. Date deceased last worked at t�=is occupation (�nonth and year� June,l9�3 •
<br /> 11. Tota.l time (ye�.?`'s ) spent in this occu�ation �0 .
<br /> 12. Birthpla.ce CitST or Toti,�n
<br /> and Furnas County,
<br /> State or Countxy Nebraska
<br /> 13. Name of Father Richard McMullin
<br /> l�. Birth�laee of F�ather City or Town No . Record
<br /> � a�d
<br /> State or C�unt�'y No. Record.
<br /> l� . Maiden nar�e of Mother Jane -----------
<br /> 16. Birthplace of Motner City or Town No Record
<br /> and
<br /> Sta,te or Country A10 Record
<br /> 17. �i�'FORMAi�'T Mrs. Duain Doan
<br /> (Address) Atlanta, Geor�ia
<br /> 18. BURIAL,CREMATION, or RF�rfOVAL.
<br /> Place Dor�iphan, NeUr. Da.te June 28, 19�3
<br /> 19. Ui1DERTAKER L,.�,���ngston-Sondermann,
<br /> (Addre s s) Gran� Is�.and,_ ATebraska.
<br /> 20. Filed JUL 1 19�3
<br /> F. S. �l'r�ite
<br /> Registrar
<br /> MEDI�AL CEi�.TIFICATE OF DEATH
<br /> 21. DATE OF DEATH June 2,�, 19�3
<br /> 22. I HFREBY CERTIFY, thG.t I attended deceased from Dec.6, 19�2 to June 21, 19�3� I
<br /> la.st sa��r her alive on June 25, 19�3 death is said to have occurred on tne date stated,
<br /> a�ove , at 2;30 P.M. The princi�?al cauae of death and related causes of importance
<br /> in order of �nset ��rer� as fol�.oti��s :
<br /> p����it�:s Da,te ��f' Onset
<br /> Dec. 6 -42
<br /> Contributive causes of imnortance not relat�d to princi��a1 cause
<br /> Polyay�t,c Kidneys
<br /> Wh�,t test confirmed diagnosis� Clinical
<br /> � 23. If deatr ZRras due to external c�.uses (violence) fill in also t��e fo3lot�ing
<br /> Accide�t, suicide or hotnicide? Date of ------ 19---
<br /> Where did in�ury occur?
<br /> Specify ?��'rlet��er in,jury occurred in inaustry, in nome, or in ?�ublic nlace.
<br /> Manner of in�ury ----___
<br /> Nature of injury --------
<br /> Z�r. T�las disease or in�ury in any trray relating �n occupation of deceased?
<br /> If so s�?ecify --------
<br /> (SignEdj W.H. Hombach M. D. ,
<br /> (Address) Grand Isla��d, Nebr.
<br /> 2J . I here�y cer�ify th��.t I personally embalmed the body of t�1e deceased named hereon.
<br /> Ja.mes D. Livingston License No. 1835
<br /> THIS CERTIFIES TH� ABOVE T� BE A TRUE COPY OF AN ORIGINAL CERTIFICATE ON FILE WITH THE
<br /> STATE DEPARTTfi:,NT OF H�ALTH, BUREAU OF VITAL STATISTICS, `:.�iICH TS THF LEGAL DEPOSITORY FOR
<br /> VITAL RFCORDS. �
<br /> (SEAL) G�1. S. Petty M.D.
<br /> ,� DTRECTOR OF HEALTH Ai?D STATE REGISTRAR.
<br /> LINCOLN, NEBRASKA Aug. 6, 19k6
<br /> Filed for record this llth day of September, 19�o,�:t 9:30 o� clocl� A.M. . (��� --�.
<br /> \
<br /> Register of Deeds
<br /> o-o-o-o-�-a-a-a-o-o-c-o-o-o-a-a-o-�-o-o-o-o-o-o-o-o-o-C-o-o-o-o-o-c-e-o-o-o-o-a-o-o-o-o-o-
<br /> AFFIDAVIT
<br /> STATE OF NEBRASKI� )
<br /> COUNTY OF HALL �ss.
<br /> Carl Kn�ekrehr�l, being first duly aworn, on oath says :
<br /> I am a resident of and have resi�.ed in Grand Isiand in Hall County and State of Nebras:�a,
<br /> for more than .�d years.
<br /> '� This affidavit is mad.e tTith res�ect to Lot 1 and the East Z4 feet of Lot 2, in Block 7
<br /> of t�1e Original to�an, now city of Grand Island.
<br /> I tr�as personally acquainted in the year 1928 with E. M. Fraker ��ho is grantee in the
<br /> deed conveying such real property as recorded in Book 73 on Page 23 of deed records of
<br /> Hall Countsr, Nebrask_a,
<br /> ; I t:4=as further personally acquainted in the year Z932 with Elsie M. Fraker, unmarried,
<br /> � t�.*l�o is grantor in the deed conveying such real property as recorded in Book 71 on Page
<br /> 591 of deea records of such Ha1.1 County.
<br /> The E. M. F�aker and the Elsie M. Fraker, unmarried, above described were, to my
<br /> personal knoti�rled�e, one and the sa.me person.
<br /> I am �aersonally acquaintPd with Ella Sagesser, one of the heirs at law of A].bert
<br /> Sagesser, deceased, and Ella M. Sage•es.s�� �rho is one of the grantors in a conveyance of
<br /> �art of a;�ove de�criUed real pro��e�ty, and �ersonally knot,r that t�ey are one and the
<br /> sa.me nerson. -
<br /> Garl Knickrelvn
<br /> Subscribed in my nresence and strorn to before me, tnis Z2t:n day of SeptemUer, 19�6
<br /> (SEAL) Clinton E. Cronin �
<br /> My cor_vnission expires M�.y 27 , 19�9 Notary Publ�s, .�j
<br /> Filea for record this l�th day of September, 1946, at 11:OC o�cloc� A.M. </(c.e:��-►.� 1,.�/��
<br /> Register of Deeds
<br />
|