|
_ _ _ �
<br /> .. � -
<br />', ���
<br /> I�IISC�LI�ANEOUS RECORD V
<br /> _ 290D6�TNCI1YBOfTIN6CO.GRAND�fLAN0,N68N. � . �
<br /> 8. AGE 82 yrs. 0 mos. 9 days iF LESS THAN ONE DAY OLD HrB. Min.
<br /> �, BIfiT�IP.LACE Winterset Iowa r
<br /> 10 . USUAL OCCUPATION Housewife
<br /> 11 . INDUSTRY OR BUSINESS own home
<br />�= FATHER Z2. NAME Dee Harrell -. �� �`� '
<br />' 13. BIRTHPLACE unknown '
<br /> MOTHER 1�. MAIDEN NAME ('iJnk. ) Daniele
<br /> 15. BIRTHPLACE Unknown
<br /> 16. (A) INFORMANT Lee Ernest VanBuskirk
<br /> (B) ADDRESS 6ll No. Mayo St. Compton !
<br /> 17. (A) REMOVAL (B) DATE Mar. q, 1948.
<br /> Burial,cremation or removal �
<br /> (C) PLACE Doniphan Cemetery, Doniphan, Neb.
<br /> 18. (A) Embalmer' s Signature Samuel L. Croninger LICEiJSE N0. 2�27
<br /> (B) FUNERAL DIRECTOR Utter-MeKinley-Hann
<br /> ADDRESS 1301 E.Pa�mer Ave. Comp�on
<br /> By J T Winstead '
<br /> 19. (A) Date Filed Mar. 1�, 19�8
<br /> (B) R.oy �.. Gil'b�rt,M.D.
<br /> Registrar' s �nature
<br /> Sy Loretta Co�ral
<br /> 20. DATE OF DEATH: Month March DAY 3 YEAR 19�8 HOUR � MINUTE 20 AM
<br /> 21. MEDICAL C ERTIFICATE
<br /> I HEREBY CERTIFY THAT I ATTENDED THE DECEASED, FROM 5-24� 3946 to 3-3-�$
<br /> THAT I LAST SAW HER ALIVE ON 3_2-1�8 AND THAT DEATH OCCURRED ON THE DATE "`'
<br /> AND HOUR SZ'ATED ABOVE.
<br /> IMMEDIATE CAUSE OF DEATH Cerebral �hromboais DURATION
<br /> DUE TO Arteriosclerosis 2� hrs
<br /> General unknown
<br /> DUE �.'0 -------
<br /> �THER CONDITION Chr. nephrosts unknown
<br /> (include pregnancy within three months of death)
<br /> MAFTOR FINDINGS PHYSICIAN �
<br /> OF OPERATIONS UNDERLINE THE CAUSE
<br /> DATE OF OPERATION TO �°�HICH DEATH SHOULD
<br /> OF AUTOPSY None BE CHANGED
<br /> - STATISTICALLY
<br /> 22. CORONER�S CERTIFICATE
<br /> I HEREBY CERTIFY, THAT I HELD AN AUTOP3Y, INQUEST OR INVESTIGATION ON THE REMAINS
<br /> OF THE DECEASED AND FIND FROM SUCH ACTION THAT DECEASED C.AME TO H-- DEATH ON THE
<br /> DATE AND HOUR STATED A BOVE.
<br /> 23. IF DEATH WAS DUE TO EXTERNAL CAUSES, FILL IN THE FOLLOWING:
<br /> �A ACCIDENT, SUICIDE, OR HOMICIDE---------
<br /> B� DATE OF INJURY
<br /> (C) WHERE DID INJURY OCCUR? CITY OR TOT��TN COUNTY STATE
<br /> (D} DID INJURY OCCUR IN OR ABOUT HOME, ON FARM, IN INDUSTRIAL PLACE, OR IN PUBLIC
<br /> PLACE? WHILE AT WORK?
<br /> (E) MEANS �F IN�URY-------
<br /> 2�. PHYSICIAN'S SIGNI�TURE F1oyd E. Neff M.D.
<br /> Address Compton, Ca1.if. Date 3-�-�8
<br /> STATE OF CALIFORNIA
<br /> DEPARTI�IENT OF PUBLIC HEALTH CERTIFICATE OF DEATH FL�DERAL SECURITY AGENCY
<br /> U.S.PUBLIC HEALTH SERVICE
<br /> LOS ANGELES COUNTY HEAL�H DEPARTMENT
<br /> DIVISION OF VITAL RECORDS
<br /> CERTIFICATION
<br /> No. �71�63
<br />� � �
<br /> This is to certify that the attached is a full, true and correct copy of the Certificat�,. ;
<br /> of DEATIi of FLORENCE VANBUSKIRK whieh is on file in this office and of which I am legal �`�
<br /> custodian.
<br /> In testimony whereof, I have hereunto set my hand and affixed my sea.l of office this
<br /> 5th day of March, 1948.
<br /> (BEAL) ROY O.GILBERT,M.D. County Health Officer
<br /> ' and Regiatrar of Vi�a1 Statistics
<br /> By Loretta Corral
<br /> Deputy Registrar of Vital
<br /> Statistic
<br /> Filed for record thia lOth day of March, 19�8, at 2 :30 o� clock P.M. �j/-���-� �
<br /> Vl �.�
<br />� �e�iater of De�
<br /> AGREE�tE�TT�-0-�-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-Q-0-
<br /> This agreement made a.nd entered into this lOth d�,y of March, 1g4�, between Gus
<br /> Ez'ic'_�sen �nd Annie M. E�icksen, his T�rife, of Cairo, Hall County, Nebrask� , p�rties of the
<br /> first ��art, �nd John E. Rounds and E11a M. Rounds, his wife, each individually, and as
<br /> spouse of the other, na.rties of the second p�.rt, TrJitnesseth:
<br /> ��Ihereas, Gus Ericksen is the owner of Lot Seven ( 7) an d Lot Eight (�) , in Block Ten (10)
<br /> Original ToT�m of Cairo, Hall County, Nebraska, and,
<br /> Whereas, John E. Rounds and E11a M. Rounds have agreed to nurchase Lot Eight (�) ,
<br /> Block Ten (10) , Origina,l Town of Cairo, Nebraska, of tnp said Gus Ericksen and raish to erect
<br /> • thereon a brick building, and,
<br />�
<br /> v�lhereas, there is noir� located u��on Lot Seven ( 7), Block Ten (10) , Original Town of
<br /> Cairo, Nebraska, �, building owned by the sa.id Gus Ericksen, and, '
<br />
|