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I�IISCELL.ANEOUS R�CORD V 21� 28056-TNiAU60tTIN6CO.CRAN01fL11ND,N[BR. � , . DEATH CERTIFICATE DEPARTP�ENT OF hEALTH Dep�.rtment of Commerce Division of Vital Statistics State File No.- - Bureau of Census 3TANDARD CER.TIFICATE OF DEATH State of Nebraska . PLA E OF A H. . �a) County Ada�ns (b) City or town Ha,sints tc) Name oP hospital or institution 406 East �j�h Street (d) Length oP stay-in hospital or institution Specify wh2ther In this eommunity 6 months years, months, days 2. USUAL RESIDENCE OF DECEASED (a) State Nebraska (b) �ounty Hall �c) City or to��rn Prosser- Rural (d) Street No. 7 miles N. E. Prosser (e) If foreign born, how long in U. S.A. - - - - -Ye�rs 3. �a) FULL T1A��"E Artimus Roswell Robinson 3. (b} If Veteran � name wax- - - - - - - - - - - - - - - - 4. Sex �I�.le 5. Color or race, �lhite 6. (a) Single, �aidowed, married, divorced- - -Married. 6. (b) Nar�e of husband or wif e Geneva Robinson 6. ( c) Age of husband or T,rife if alive- - -yrs. 7. Birth date of deceased Nov. � 1�6� Month Day Year �. AGE Years Months Days If less than one day 7� �F 24 - - - -Hrs.- - - --Min. 9. Birthplace Swanton Vt. lO.Usua1 occupation Retired farmer 11.Industry or business- - - - - - - - - - - - (12. Name Cethas C. Robinson Father (13. �3j.rthplace - - - - - - Vt. tl��:_�aclen;; nar�e Phebe Shepard Moth.er (15. Birthplaee- - - - - - - �t. 16. (a) Informant ' s own signature I�irs. A. R. Robinson (b) Address Prosser, Nebraska 17. (�.j ''>�zrial & Removal (b) Date thereof Apr. 5 1947 Month D�,y Year • , � c) Place-Buri�l or creamtion Rosedale, Nebr. , Hall l�. (a) Signature of funeral director Geddea Funeral Home (b) Address Grand Island, Nebraska Edward L. Dier 19. (a) Date Received lo�al Registrar 4-7-47 (b) Registrar' s Signature, Z�EDICAL CERTIFICATION 20. Date of death- P�onth Apri1 day 2 19�+7, 12 hour 15 minu�Ge A.M. 21. I hereby certify that I attended tne dece�,sed from 11-1 19�+6 to 4-1 1947 that I last say him a.live on 4-1 19�+7 and that death occured on the date and hour stated above. Immediate cause of death :: < � ._ _ � . `. - � Duration � Interstelial nephritis - - - - - - - - - - -10 yrs. Chronic myoc��.rditie- - - - - - - - - - - - - 10 yrs. Dueto- - - - - - - - - -- �ueto- - - - - - - - - - - Other con�iti�ns- -(Incl��e nregnancy within three months of death) PHYSICIAN • Ma,jor findings: Underline the cause to which �f o�erations- - - - - - - death should be charged Of autopsy- - - - - - - - - s�atistically. 22. If death was due to external caused, fill in the following: �a) Accident, suic�de or homicide �specify)- - - - - - - - (b) Date or oecurence � c) Where did in,�ury occur - - - - - - - - - - - - - - - - - - - - - - - - -- �City or town County State (d) Did. in�jury occur in or about home, on a f arm, in industrial plaee, in publie place Specify type of place- - - - - - - - - - - - - - - - -- - - - - - - - - - - - -- �iile at work- - - - - - (e) Means of in,�ury- - - - - - - - - - - - - - - - - 23. Signature C. �d. Guildner (M.D. ) � Address Hastin�s, i�ebr. Da�e signed 4-5-57 This is to certif y that the above is a true and correct copy oP the original certificate� for?�rarded from rny office to tr��e dep�.rtment of Vital Statistics, State of Nebraska. Dated at Hastings, Adams., County, Nebraska, this 19th day of November, 19�7• Edward L. Dier, ( CORP) City Clerk and Lo�al Registrar , (SEAL) , STATE OF NEBRASKA ) COUNTY OF ADAgZS )ss. This is to certify that I, ED?�tARD L. DIER, City Clerk in and for CITY OF HASTINGS ) the Cit� of Hastings, County of Adams, State of Nebraska was duly appointed by the State Dep�.rtment Bureau oP Vital Statistics as