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<br /> NII�CEI�L�ANEOUS R�CORD V
<br /> Y9058-THQ 11U6tlfTINE CO.iR11ND ISLAND.N[Bp.
<br /> THIS CERTIFIES THE ABOVE T� BE A TRUE COPY OF AN ORI(�INAL CERTIFICATE ON FILE WITH THE
<br /> STATE DEPARTA4ENT �F HBALTH BUREAU, OF VITAL STATISTICTS,WHICH IS mHE LEG,AL DEPOSITORY
<br /> FOR VITAL RECORDS.
<br /> W. 8.Pettg M.D.
<br /> (SEAL) Director oP health and state
<br /> i9gistrar Lincoln, Plebraska 8ept 3,
<br /> �F7
<br /> 25, I hereby certify I personally embalmed the body of t he deeeasec� named hereon.
<br /> Jamea D.Livingston License No.1�35. .
<br /> Filed for record this 1�+ day of October, 19�+7, at � o' clock A.M.
<br /> �� �
<br /> Register of Deeds
<br /> -o-o-a-o-o-o-o-o-o-o-o-o-o-o-o sTATE OF NEBRASKA-°-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-c�-
<br /> DEPARTMENT OF HEALTH
<br /> BUREAU OF VITAL STATISTICS
<br /> STA.NDARD CERTIFICATE OF DEATH
<br /> DEPARTI�IENT �F COMr�IERCE
<br /> BUREATJ OF THE CENSUS Social Security No. - - - - - - - - - State File No.- - - -
<br /> l. PLA E OF DEATH: 2. U UAL RESIDENCE OF DECEASED:
<br /> (a) County Hall (a) State Nebraska (b) County Hall
<br /> (b) Cit or tot�rn Grand Island (c� City or town Grand Isla.nd {IP outside
<br /> Y
<br /> ,
<br /> (If outside city or town limits, write RURAL) city or town Iimits, wri'te RJRAL)
<br /> (c) Name of hosnital or institutiom: (�.) Street No. 70� West 4th St.
<br /> 200 block on East 3rd St. (If not in (If rural give locat�q,n)
<br /> hosni.�al or institution, ��arite street number
<br /> or location�
<br /> (d) Length of stay: In hospital or institution ( e) If foreign born, how long in U. �.A. years.
<br /> In this community 27 years
<br /> (s ecif whether rs. mos. or da s) M AL E CA ON
<br />' 3. a ULL NAME Dick eorge Stromer� 20. Date of death:Month August day 9th, 1947.
<br /> 3. (b) If veteran 11 hour 30 minute A.M.
<br /> name war- - - - - - - - - - - -- - - - 21. I hereby certiPy that I attended the
<br /> . ex ma,le . o or or race . a ingle, deceased from- - -, 19- - -, to- - - -
<br /> tiThite widowed, married 19--; that I last say h-- alive on- - - ,
<br /> divorced,marriedl9--¢and that death occurred on the date
<br /> 6(b) Name of husb�,nd or wiPe Mattie Stromer and hour stated above. Duration
<br /> 6(c) Age of husband or wif e iP alive - - -yrs. Immediate cause of death heart attack
<br /> 7. Birth d�.te of deceased May 3 1�72
<br /> (month) (da ) ( ear) Dueto- - - - - - - - - - - - - - - --
<br /> �. AGE:Years Months ays f less than one day
<br /> 75 3 6 - - -hr.- - - -min. Due to- �- - - - - - -- - - - - - -- -
<br /> �9. Birthplace Minonk Illinois Other conditions- - - - - _ _ _ _ _ _ _
<br /> (City, town, or county) (�tate or f'oreign count�y) (Include pregnancey within 3 months of
<br /> 10. Usual occupation F.etired Manager death) old age PHYSICI,AN
<br /> 11. Industry or business Farmers Union Elevator Ma,�or findings: UnderZine the
<br /> Mother Father Of operations- - - - - - cause to which
<br /> Of auto s - - - - - - d th should b
<br /> 12. N me Geor e Stromer y - ea e
<br /> � g P
<br /> 13. Birthplace- - - - - -- -Germany charged statist-
<br /> (City, town, or county) (State or Poreign country ically. -
<br /> 14. Maiden Name Gretke MentZ �
<br /> 15. Birthplace- - - - - - -Germany 22. IP death were due to external causes, Pill in
<br /> I (City, town, or county) (State or f'oreign country) the followin�:
<br /> 16. (a) Informant' s own si nature Mrs. D. G. Stromer (a) Accident, suicide, or homicide , � specify)
<br /> g
<br /> �b Address Grand Island Nebraska. (b) Date of occurrence- - - - - - - - -
<br /> ) ,
<br /> 17. �a� ; Burial & Removal Date thereoY Aug.l , 1947 (c) Where did in�ur occur- - - - - - -
<br /> (Burial, eremation, or removal) (Month�(day) �y�ar) (City or town� ( County) (State)
<br /> ( c) Place:burial or cremation Lutheran Cem. Glenvil3�
<br /> 1�. (a) Signature of Puneral director Geddes Funeral Home '
<br /> (b) Ad�.ressGrand Ialand, Nebr. (d) Did in,�ury occur in or about home, on
<br /> �a) AUG 15, 1947 farm, in industrial place, in public
<br /> (Date received loca.l register) plaee- - - - - - - - - - - - - - - - -
<br /> (b) F. S. White ( Speeify type of lace)
<br /> (Registr�.r' s Sign�,ture) While at work- - - -(e�Means oP in,jury
<br /> �j. Signature Donald H. Wea.ver Coran:e�r
<br /> Address lst Natl. Bank Bld�. Date signed
<br /> �/11/47 Grand Island, Nebr. o95C
<br /> THIS CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL CERT�FICATE ON FILE i�ITH THE ST�.TE
<br /> DEPARTMENT OF HEAL'TH, BUREAU OF VITAL STATISTICS, '�+TFIICH IS THE LEGAL DEPOSITORY FOR VITAL
<br /> RECO�DS.
<br /> ( SEAL) W. S. Petty M.D.
<br /> Director of Health and State Re�istrar
<br /> L3neoln, Nebraska Oet 6, 1947.
<br /> N. B. This is a permanent record. Every item of information should be carefully supplied.
<br /> AGE should be stated EXACTLY. Exact statement of' occupation is iiportant. Give cause of
<br /> death in p�ain terms. TO BE ACCOP�IP�.ISHED tA,1HEN BODY IS EMBALMED
<br /> 25. I hereby certify � personally embalmed the body of th� deceased named hereon.
<br /> Emmett H. Benson License No.1706
<br /> Filed for record the 14 day oP October, 19�+7 at 9 o 'clock A.M. � � �
<br /> Register of Dee�s.
<br />� o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-c-o-o-o-a-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-a
<br /> .
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