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1vIISCEI�L�ANEOUS �.ECORD V
<br /> 1�3
<br /> 29058-TN�AU6UITINECO.GR11MD1lLAND.NlBR. h � - '
<br /> :�FFIDAVIT
<br /> 9tate oP Nebraska)
<br /> SS �'0 1�tH�M T� MAY CONCERN;
<br /> County oP Hall )
<br /> I, Paul C. Ho�mberg, being first duly sworn on oath depose
<br /> and say; that '� am a resident of Grand Island, Hal1 County, Nebraska; and that I have
<br /> resided in said City since August 25, 1924; that I was well and personally acquainted with
<br /> Joseph T. Steward who resided in Grand Island, Nebraska; that I lived beside Joseph T.
<br /> 3teward for several years as his neighbor and that I as his attorney looked after many of
<br /> his business affairs; that I personally know of my own knowledge that J. T. Stewaxd who ae
<br /> arantee took title to Lot Eight (�) in Block Twenty-eight (2�) in Russell Wheeler' s Addition
<br /> to tne City of Grand Island, Nebraska, Yrom Ea.rl �T. Peacock �nd Mae Peacock, husband and wife
<br /> Grantors, and Joseph T. Steward who under date of February 2�, i935 conveyed said premises to
<br /> Eva Gertrude Whitwer, to be one and the same person not withstanding the discrepancy in the
<br /> use oP names.
<br /> Further this affiant saith not. Paul C. Holmberg
<br /> Subseribed in my presents and
<br /> sworn to before me �Yii:s 3rd
<br /> day of October, 19�7
<br /> Ra,y M, Higgins
<br /> (SEAL) Notary Public.
<br /> My commission expires Jan 20-19�j3. ^
<br /> Filed for record the 3 day of October, 1947 at 11:15 0 ' clock A.M. �-�-��� `�`�
<br /> Register of e�eds. �✓
<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-o-o
<br /> STATE OF NEBRASKA
<br /> DEPARTMENT OF HEALTH
<br /> Division of Vital statistics
<br /> STANDARD CERTIFICATE OF DEATH
<br /> DEPARTMENT OF COMP�IERCE
<br /> BUREAU OF THE CENSU3 Serial Security No. 3tate File No.
<br /> l.PLACE OF DE�TH: 2.USUAL RESIDEI`�CE OF DECEASED:
<br /> �a) County Hamilton (t�) State of Nebraska
<br /> 4b) City or town Rural (b) Cou�ty Hamilton
<br /> ' ( If outside city or town write RURAL (c) City or town Rural
<br /> (c) Name of hospital or institutivn : (If outside city or town
<br /> 52 Mi. S.'uJ. of Phillips limits, write RURAL
<br /> (IP not in hospital or institution , (d) Street No. S� Mi. 9.W.of
<br /> write street number or loca�ion) Ph311i s
<br /> (d) Length of atay: In hospltal or onstitution----- rura g ve oca ion
<br /> In this community ------------------ (c) If forei�n born,how long
<br /> (Specify whether yrs.mos.or days) in U.S.A� years
<br /> 3 (a) FULL �tAME Arthur C. Schwarzentruber J
<br /> 3 (b) If vetera,n, name �aax. ----------- MEIIICAL CERTIFICATI�N
<br /> 5. Color or 6 (a) Single, widowed, married, ��0) . Date of Death:
<br /> 4. Sex Male race whit� divorced married Month June day 11 194?
<br /> 6 Qb) Name oP husband or wife 7 hour 00 minutes A.M.
<br /> Clara arat' 6 (e) Age of husband or wife if alive---yrs. (21) . I hereby certify that
<br /> 7.Birth date oP deceased June I attended the deceas�d from
<br /> Iont Day Year ----,19----, to--,19---:
<br /> 9. Birthplace MeClain Go. Illinois. that I last saw h-- alive on
<br /> —CZi�,j�own, or county tate or foreign country) -------, 19---:
<br />; lO.Usual oecupat�on Farmer. and that death occured on the date
<br /> � 11.Indus�ry vr buaineas Farming. and hour stated above
<br /> (Father ( 12.Name John H.Schwarzentruber, Dead on arrival Duration
<br /> ( 13. Birthplace Henry County, Iowa. Due Probably cornary decease
<br /> ( (City, town, or county) (State, or foreign country) Due to - - -------
<br /> Mather ( 14.Maiden name Anna Otto, Other conditions ---------
<br /> ( 15.Birthplace No record, (Inelude pregnanc within
<br /> ( (City, town,or county) (3tate, or foreign country) 3 months oP death�
<br /> 16. (a) Informant � s own signature Mra.Lamont Levi, Physician
<br /> (b) Address arand Island, Nebr. Ma�or findings
<br /> 17. (a) Burial (b) Date thereof 6-14-4 Of operation
<br /> �buria�, cremation,or removal� nth, Day) (Yeax) Of autopsy
<br /> (b) Place: burial or cremat�.on Phillips, Nebr.
<br /> 1�. (a) �ignat�re oF funer�l dlrector Livings�on-Sondermann, Underline
<br /> (b) Address arand Islanc�, Nebr. the cause to which
<br /> 19. (a) June 11, �+� (b) R.03.son death should be
<br /> '�3�te re����e local regiatrar eg s rar�s charged statistically
<br /> Signature. 22. If death were due to
<br /> ext��nal cause, fill in
<br /> the followin�;
<br /> �a) Aecident,,suicide,or
<br /> homicide �apecifq)----
<br /> (b) Date of Occuranee ----
<br /> (c) �i�re did in ur occur
<br /> city or town ounty'�
<br /> � tState )
<br /> (d) Did in�ury o ceur Q�n
<br /> �' , or about home, on �arm,
<br /> "� in industrial plaee,
<br /> w'� in ublic lace
<br /> �;;� pec fy type of place
<br /> '� While at work (e) Meana
<br /> � of in�ury
<br /> 23. Signature Donald B. �
<br /> �lenburg (M.D. )or other ',
<br /> Address Auror�,, Nebr. I
<br /> Signed June 11, 194� ' �
<br /> � 1
<br /> i : �_�..�.�J
<br />
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