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<br /> 1vIISC�LLAN�OUS R�CORD V
<br /> 29058-TNEAUGUSTINEC0.6RANDIgLAND.NEBR. � �
<br /> 17• �a) Burial,cremation or removal Burial
<br /> (b) Date thereof Nov. 14�, 19�� (c) P1.ace; burial or cremation (�rand Isl.and, Nebr.
<br /> 18. (a) Signattzre of f�..�neral d3.rector Ge:�des Fun�ral Home
<br /> (b) Addres� Grand Island, N�br.
<br /> 39. (a) Da�e reeeived loca]. registrar Nov. 13, 19��f-.
<br /> (b) F.S.White Registrar' a gignature
<br /> MEDICAL CERTIFICATION
<br /> 20. Date of de�,th: N1Qnth Nov. day 11 19��. ------hr. ---- minute-----------M.
<br /> 21. I hereby cer�ify that I attended the deceased from ------- 19--, 'Go ----------19 ,
<br /> tha� I last saw h---- al3.ve on -------_19----; and that death accurr�d on the
<br /> date and hour stated above
<br /> Immediate caus� of dea�h Acc�.d�ntal Death. Crushed Skull
<br /> �ue to Auto-Train Co3lision 170 A
<br /> 22. Tf d�ath was du� to external caug�s fill in the followin�:
<br /> (a) Acciden�, suieide, or homicide � sp�cify) Aecid�nt
<br /> (b) Dat e of oc currence ii/�.a./�9��
<br /> (e� Wher� did in�ury occur� ? Hall Gounty.
<br /> (d Did in�ury occus�.in or about home, on farm, in indus�Gria1 plant, in publ.5,c place �
<br /> H3.ghway & R.R. Cro�s�ing
<br /> While a� work? -------- (e) Means of in,jury
<br /> 22. SignaturE John F. McCarthy Co. Coroner
<br /> Addr�ss Grand Island, Date si�ned 11/l�/4�.
<br /> Nebraska
<br /> I hereby certify I p�rson�.l3,y embalm�d the body of the deceaqed named hereon.
<br /> J.Walter G�dd�s
<br /> �ic�nge No. 1738
<br /> THIS CERTIFIE3� THE ABOVE TO BE A TRUE COPY OF AN ORTGINAL CERTIFICATE ON FILE WITH THE
<br /> STATE DEPARTMENT OF HEALTH, BUREAU OF VTTAL STATTSTTCS, WHICH IS THE LEt�AL DEPOSITORY
<br /> FOR VSTAL RECORDS.
<br /> (SEAL) W. S. P��ty M.�._
<br /> DTR�CTOR OF7 HEALTH AND aTATE REGISTRAR
<br /> LINCOLN,IVEBRASKA Mar. 10, �.g�7
<br /> Fi1.ed for recard this 2 day of April, 19�7, a� 3 �30 0�clock P.M. ��.� U� �
<br /> Regis�er of�eed�
<br /> 0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-Q-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-�-0-0-0-0-0-0-0-0-
<br /> AF'FIDA'TIT
<br />� "TATE of Nebrr�.s'�a) �
<br /> ss. R. R. Horth, bein� first c�.uly sY�rorn, dex»�es and say� tha.t he is a
<br /> Ha11 County ) resident of Ha11 Gounty, Vebraska, anc'ti has been such for rnore than
<br /> forty years 1a�t p�.st.
<br /> Affia.nt further s��.,ys that he is ��re11 and nersonally acquainted �.�ith EZekiel E. Dominy,
<br /> t�ho received th� title to Lot Four (�-�) , in Block One Hur��ar�d and Thirty-two (132) , Union
<br />, Pa.cif3�c RailUTay Comx»ny' s �ecand Addition to Gr�.nd Island, �n Ha11 County, N�braska from
<br /> Adah B. Schultz �n�. husb��nd, by warranty deed recorded in Book 30 of Deeds at page �+2� of
<br /> the Deed. Record.s of Ha11. C�unt,y, Nebr�sr��., anc� with E. E. Dominy, who conveyed said premises
<br /> to Julia A. Br€j.un, by r�T�rranty deed recorded in Book 5� �f Deeds a.t Uage 37� of the Deed
<br /> Records of H�,11 County, Nebr�.sk�, and affi�nt kno�vs of his own ��erson�l knowled�e th�t the
<br /> sa.i� Ez�ekiel E. Domin anc� E. F. Dominy is one and the same person. An� f2arther affiant
<br /> Y
<br /> ��ith not.
<br /> A. R. Hor th
<br /> Subscribed in my pre�ence and s��rorn to before me on this 21st day of July, A. D. 1g20.
<br /> ( SEAL) Chas. G. Ryan
<br /> Notary Public
<br /> I My commission expires Februar,y l, �925
<br /> Filed for record the 3 d��.y af April, 1911-7 at 11 0 ' clock A.M. �-r��-d � �I
<br /> Register of 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-o-
<br /> AS�IGNr�-��;NT OF RENTS
<br /> ASSIGNP�IENT OF RENTS
<br /> KNOW ALL ?�4FN '�Y '^NESE PRE�Ei�tTS: Tha.t ��ae, thP undersi�ned J�.r�es G. Johnson and Lucille J.
<br /> Johnson, Hu�b�nc� anr� '^Tife, e��,ch in h1s �.nd her own ri�ht of Grand Island, County of H�,11,
<br /> Ftate of T7Pbraska for and. in consideration of SIX TF30?J"A�3D mHI�EE H�JNDRED AND NO/100 'DOLLAR�
<br /> �o us �.s � lo��.n in hand. 7��id. by Union Na..tional Life Insur�nce Comvany �f Lincoln, in the
<br /> raunty of Lanc�stPr C�nd State of r�?Qbra.sk�,; ��.nd other good anr?_ v�.1u�.ble consider�,tion,
<br /> the receit:�t ?<<rt�ereof is hereb;� ,��.ckno���1_edged, do hereby a.ssign, tr�.nsfPr, �.nd �et over to
<br /> \ LS
<br /> � tJnion Nation<�,�_ Life Insurance Com��any a.s collt�teral Securi �,� for saic� 1o��.n, for so long
<br /> h a,s saic� loan or �ny T��rt thereof rema.ins un���ic�, the rPnts an� revenue �ccruin�; for the
<br /> q
<br /> period of the duration of the loan �.bove mentior�ed, up�n the follo��rinQ c?escribect prop�rt�,�
<br /> t t d i�. C urit of H�11 5tate of Nebraska to �t�.�: '
<br /> si ua e o .
<br /> Y , , ,
<br /> �� Lot Eleven (11) of Abranamson' s Suudivision o�' 81oc�s Forty- two �42) oY Charle$ Wasmer's
<br /> 3econd Addition to the C3.ty of Grand Island, Ha11 County, Nebraska
<br /> �` And w� hereby authorize and emx�ower Union National Life Insurance Company to act for us,
<br /> � and rent the above described premises or any part thereof, �.nd in our p1.�,Qe collect �.nd
<br /> receipt for sa.id rent, either monthl.y, qua.rterly or yearly, �,s it may see fit, and in
<br /> default of the payment of �aid rent or any �art thereof to proceed in its own name �by
<br /> suit or suits �.t law for the recovery thereof in such manner as it sha11 deem fit.
<br /> This assignment of rent is bein�� made for th� exnress purpose of h�.vin� the rent
<br /> collected hereunder applied to ���.yments of principal, interest and fines on the loan o�'
<br /> � �6, 300.00 above d.escribed, a.s a�reed by us to be paid in the �real eatate mortgage dn the
<br /> propert,y above described securing said loan.
<br /> Sa,id Assi�nee m�,y in its d�scretinn use the rents so faY� as nece�sary for the •purpose
<br /> of ma:king such r. epairs upon the premises a� , in its ,�uc��ment 'm�.y be proper and m�.y use
<br /> s�.id rents so far as necessary f'or the payment of insurance ��remiums and taxes upon said
<br /> premises, or any other payments to be m�.de by us under the terms of the mortgage above '
<br />
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