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<br /> �Isc�����oUS �.�coRD v
<br /> 29058-TNEAUOtlfTIXECO.YMNDI6L�ND.N[BR. . � . � . .
<br /> DEATH C�?TIFICATE, �C.
<br /> A F F I D A V T T .
<br /> STATE OF I�IEBRASKA :
<br /> ss. Mary Stockman, being first duly sworn on oath, deposes and states
<br /> COUNTY OF HALL : that she is a resident of Grand Island, Hall County, Nebraska;
<br /> that she was well acquainted �aith Lucillia Vandevier and her hus-
<br /> band, Edward V. Vandevier; that Affiant lived in the premises right South of where Mr. and
<br /> Mrs. Vandevier residPd and that Affiant knows, of her own personal knowledge, Ed Vandevier,
<br /> al5o known as Edward V. Vandevier, died on or about the 20th day of March, 1g29; and that he
<br /> - worked as a nurse at the Soldiers � and Sailors � Home located at Burkett, Nebraska.
<br /> Affiant further deposes and states that t?�e said Lucillia Vandevier and husband owned
<br /> the premises located at 2321 North LaPayette Street, �ahich is also more particularly des- +
<br /> cribed as Lot Ten (10) , Block Eleven (11) in College Addition to West Lawn, an Addition t� ��''`��'�°"'
<br /> the City of Grand Island, Hall County, Nebraska.
<br /> Affiant furthPr de�oses and sayeth not.
<br /> Mary Sto ckman
<br /> Subscribed and sworn to before me this first day of November, 194�.
<br /> (SEAL) Wm. P. Mullen
<br /> otary Public.
<br /> My commission expires M�,y �4, i9�+9
<br /> NFBRASKA DEPARTMENT OF PUBLIC WELFARE Do not write in this
<br /> B'JREAU OF HF.,ALTFi--DIVISION OF VITAL STATISTICS space ;
<br /> CERTIFICATE OF D�,TH �3��'S ``
<br /> 1. PLACE OF DEATH �'�� .
<br /> County Hall
<br /> Township ( If death occurred in a hoepital
<br /> City Gr�nd fsland No. 2321 Street N. Laf. ( or institution give its NAME
<br /> 2. FULL NAME Edward V. Vandevier ( instea,d of stree� and number
<br /> Regidence Grand Island Nebr.
<br /> Leng'th of residenee in ci�y or town where death occurred yr. mo. da. How long in
<br /> U. S, if oP foreign birth yr. mo. da.
<br /> P�SONAL AND STATISTICAL PARTTCUL.ARS
<br /> 3. 3EX Male ,
<br /> Z�. C�LOR or RACE White
<br /> 5. Single Married Widowed Divorced-----Married
<br /> 5a If married, widowed or divorced � �
<br /> HUSBAND of or�WIFE of Lucillia
<br /> 6. DATE OF BIRTH (mo. ) Oct (day) 17 (yr. ) 1�71
<br /> 7. Age Years 57 Months 5 Days 3 If Iess than 1 day hrs. or min.
<br /> �. OCCUPATION OF DECEASED —
<br /> (a) Trade, profe�sion, or particular iknd of work Labor
<br /> (b) General nature of industry, business, or establishment in �which employed �
<br /> (c) Name o� employer '� '
<br /> 9. Birthplace City or town and State or country Iowa *f
<br /> 10. Name of Father. Michel � �
<br /> 11�. Birthplace of Father City of town <�.nd State or country. N.Y. "
<br /> 12. Maiden name of �dother '~�Cot�ld not read it
<br /> 13. Birtriplace of Mother City or town and tate or country N.Y. �' ' """
<br /> 11�. Informant Mrs. E. V. Vandevier
<br /> Address Grand Island
<br /> 15. Filed MAR 22, 1929
<br /> Registrar Clifford
<br /> MEDICAL CERTIFICATE OF DEATH
<br /> 16. DATE OF DEATH March 20, 1929
<br /> Mon�h Day Yea,r
<br /> 17. I HEREBY CERTIFY, That I attended deceased from March 192g, to March l� 1929 that I la,st
<br /> saw Mar 1� alive on Mar 1� �92g and �h�.t de�.th occurred on the date above stated, at 9 P.M.
<br /> C�B� 0�''bEATH (Deatlls from violence, give names and nature of in,jury, wheth:e� accidental,
<br /> suicidal, or homicidal) . Myocarditis 90 (duration) 3 yrs. mos. da.
<br /> CONTRIBUTORY an attack of Flu (dur a�ion) yrs. mos. da.
<br /> l�. tahere was disease contracted if not at place o�deat�i.'—at home
<br /> Did an operatlDn precede dea.th: No Date of Cause
<br /> Was there an au�apsy: No
<br /> Wh�,t test confirmed diagnossi: Clinical history
<br /> (Signedl I�. Ph�lan M. D.
<br /> �Ad ress
<br /> 19. Place or� burial, cremation or removal Doniphan Nebr. Date of Burial 3/23,-29
<br /> 20. Underta.ker F.G. Evans Address Grand Island
<br /> THIS CERTIFSES THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL C�TIFICATE ON FILE WITH THE STATE
<br /> DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WH3CH IS THE LEGAL DEPOSITORY FOR VITAL
<br /> REC�RDS. ( CORP)
<br /> t s�� W. S. Petty. M.D.
<br /> `+ �' RE 0 0 E AN A E
<br /> REGTSTRAR LINCOLN, NEBRA9KA
<br /> Nov 3 194�
<br /> Filed Por record this 5 day of November 194�, at 10:45 o' clock A.M. .
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<br /> � �iste of e s
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<br /> AFFIDAVIT:
<br /> IN THE MATTER OF THE TITLE TO LOT STX {6) IN BLOCK FIVE (5) OF '�KOEHLER PLACE"
<br /> AN ADDITION T(�THE CITY OF GRAND ISLAND, HALL COUNTY, NEBRASKA.
<br /> STATE OF NEBRASKA ) $�� Glenn H Geddes, being first duly sworn upon his oath deposes '
<br /> H,ALL COUNTY: ) and says, that he is a resident of Grand Island, Hall County, I,
<br /> Nebraska; that he is a mortician and funeral direc�or, having his principal place of businesa j
<br /> in the City of Grand Island, Nebraska; that he was well and personally acquainted with
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