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<br /> NIISC�LI�ANEOUS RECORD V
<br /> 29088-TN[A06UiTINECO.ORIINDIELIIND.NlBR. � . � � . , . �
<br /> CER2IFICATE OF DEATH NEBRASKA (STATE) DEPARTMENT OF HEALTH
<br /> Division of Vital Statistics
<br /> STANDARD CERTIFICATE OF DEATH
<br /> DEPART2�'IENT OF COMMERCE
<br /> BUREAU OF THE CENSU9 Social Security No. . .Dione. . . . . . . State Ffile No. P12324
<br /> 1. PLACE OF DEATH:
<br /> (a) Coun�y Lancaster
<br /> (b) City or town Hickman
<br /> (e) Name of hospital or inatitutlon:
<br /> (d) Length ot' a�ayt Tn hospital or ln+atitution
<br /> In this community 65 years
<br /> 2. USUAL RESIDENCE OF DECEA�ED:
<br /> �a) State Nebraska (b) County Lancaster
<br /> (e) Gity or town Hiekman
<br /> (d) Street No..
<br /> H-140
<br /> (d� IP foreign born, how long in U.S.A.:
<br /> 3 (a) FULL NAME George Albert Heupel -
<br /> 3 (b) IP ve�Geran, name war no
<br /> 1�. Se� Male
<br /> 5. Co1or or race �Jhite
<br /> 6 a� 9ingle, widowed, married, divorced Widowed
<br /> 6 �b) Name of husband or wiPe Ada Heupel
<br /> 6 ( c) Age of husband or wife if alive yrs.
<br /> 7. Birth date of deceased Mar. 21 18`�`�
<br /> �. AaE: 8`t� Years � Months 7.� Days If leas than one day hr. min.
<br /> 9. Birthpl.ace Fennimore Wisconsin
<br /> 10. Usual occupation Farrner
<br /> 11. Industry or business Grain fa,rming
<br /> Father 12. Name Adam Heupel
<br /> � 13. Birthplace unknown Germany
<br /> Mother 1��. Maiden name Eva Heupel
<br /> 15. �3irthplace unknown aermany
<br /> 16. (a) Informant �s own signature W. L. Heupel
<br /> (b Address Cairo, Nebr.
<br /> 17. (a Burial (b) Date �hereof Dee. 11 19�+3
<br /> (c) Place: burial or cremation Hickman, Nebr.
<br /> 1�. (a Signature oP fur� �eral director Thyo Broekema
<br /> (b; Addr�ss Hickman, Nebr.
<br /> 19• �a) Date reeeived local registrar Dec 15, 1.943
<br /> (b) Reglstrar� s signature Selma H. Walvoord
<br /> MEDICAL CERTIFZCATTON
<br /> 20. Date of death: Month Dec. day 9 1g43
<br /> About 5 hour minute A.M.
<br /> 21. I hereby certify that I attended the deceased 2'rom Dec. �, 1943, to Dec. 9, 1943; that
<br /> I last saw h a11ve on Dec. �, �g43; and that death occurred on the date and hour stated
<br /> above. �`
<br /> Immedia�e cause of death
<br /> aoronary occiusion Dura'Gion 1 day
<br /> Due to Underline the cause '�o which
<br /> Due to 9�a death should be charged sta-
<br /> Other condition8 tistically.
<br /> (Include pregnaney within 3 months of death) FHYSICIAN
<br /> Ma,�or fi ndings:
<br /> Of opera�ions
<br /> OP autopey
<br />, 22. I� death was due 'Co externa. causes fill in the Pollowin :
<br /> , �;
<br /> (a) Acciden� suicide or homi id s
<br /> , , c e t peci�' )
<br /> Y
<br /> (b) Date of oacurance �
<br />, ( e} Where did in�ury occur.
<br /> (d) Did 3n,�ur occur �n or abou� home, on farm, in industrial place, in public place:
<br /> �
<br /> While at work.
<br /> 23. Signature �. H. Kopleton (M.D. or other)
<br /> Address Hickman, Nebr. Date algned 2-10-43
<br /> 25. I her'eby certify I personally embalmed the body of the deceased named hereon
<br /> Thyo Broekema License No. 1308
<br /> THIS CERTSFTES THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL CERTIFICATE ON FILE WITH THE STATE
<br /> DEPARTMENT OP' HEALTH, BUREAU OF VITAL STATISTICS, WFiICH ZS THE LEGAL DEPOSITORY FOR VITAL
<br /> RECORDS.
<br /> (CORP) W. S. Petty, M.D.
<br /> (SEAL) DIRECTOR OF HEALTA AND STATE REGISTRAR
<br /> LINCOLN, NEHAASKA (Not Da,ted)
<br /> • Filed for record this 16 day of October 194�, at 1Ot30 o � clock A.M. ,
<br /> 0
<br /> . e a t� o f e
<br /> 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-t7-0-0-0-0-0�� '
<br /> AFFIDAVIT
<br /> AFFECTING THE TITLE TO LOTS 256-257-258-260-261-262-263 AND 279 I�i WE3T LAWN, iN HALL
<br /> COUNTY, NEBRASKA, AND PART OF THE SE� OF THE SE� OF SECTION 8, TOWNSHIP 11 NORTH, RANGE 9 ,
<br /> WEST OF THE 6TH P.M. , IN HALL COUNTY, NEBRASKA.
<br /> STATE OF NEBRASKA�
<br /> ss
<br /> HALL COUNTY )
<br /> John Allan, being f'i.rst duly sworn, upon oath deposes and says:
<br /> That he is, andhas been for more than 38 years last past, a resident of Grand Island,
<br /> Hall County, �tebraska,
<br />
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