|
�����
<br /> NIISCELI�ANEOUS RECORD V
<br /> 29058-TNH11tlOUf71NEC0.CRANGIlLAND.NEBR. � - � �� �
<br /> 2.USUAL RESIDENCE OF DECEASED: �
<br /> (a) State Nebr
<br /> (b) County Ha11 �
<br /> ( c) City or town Grand Island
<br /> (d.) Street No. 610 S. Monroe St.
<br /> ( e) If foreign born, how long in U. S.A.'. . . . . . . . . . .years.
<br /> 3(a) FULL NAME Merl Covert Fisher
<br />; 3 (b) IP vetFran, n�ne war
<br /> LE. Sex Ma1 e
<br />� 5. Col:or or race t��hite
<br /> 6(a) Single, widowed, married, divorced-----Maxried �
<br /> 6(b) Name of husband or wife Mary Fisher
<br /> 6( c) A�e of husband or taife if alive. . . . . . . yrs. '
<br /> 7. Birth date of decea.aed Sept. 17, 1�97 `
<br /> (Month(Day(Year)
<br /> �. AGE: Years 51 Months 1 Days � If less than one day. . . . .hr. . . . . . .min.
<br /> Q. Birthplace Doniphan Nebr
<br /> 10. Usual occupation Owner & Operator
<br /> 11. Industry or b�zsiness Grocer� Store
<br /> Father 12. D?ame George J. Fisher
<br /> 1 . Birthplace Sutton, Nebr
<br /> Mother 1�. Gertrude Carson
<br /> 15. Birthpl.ace Harvard Nebr �
<br /> 16. (a) Informant ' s own signature Mary Fisher
<br /> (b)Address Grand Island, Nebr
<br /> 17. (a) Burial (b) Date thereof Oct. 29, 194� ( c}P1ace; burial or cremation Grancl Tsland,Nebr
<br /> 1�. (a) Signature of funder�l director Geddes Funeral Home
<br /> (b) Address Grand Island Nebr ,
<br /> 29. (a) oCT 27 19�� .
<br /> (Date receivPd local registrar)
<br /> (b) F. 3. tit�hi t e
<br /> (Registrar� G �ignature)
<br /> MEDICAL CERTIFICATION
<br /> 20. Date of death: Month Oct day 25 194� 7 hour P.M. minute. . . .M.
<br /> 21. I hereby certiPy that I. attended the deceased from July, 194�, to Oct 25, 1�4�; that I
<br /> last saw him alive on Oct 25, 19�F�;and that death occurred on the date and hour stated above.
<br /> Immediate cause of death myocardial degenerat�on Duration
<br /> Due to sev�re as�hma 30 yrs
<br /> bronchiectasis .
<br /> Due to. . . . . . . .
<br /> Other conditions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .;. PHYSICTAN
<br /> (Snclude pregnancy t�rith 3 months of death) Underline the cause to which
<br /> Ma�jor findingsc death should be char�ed
<br /> Of operations �tatistically.
<br /> Of autopsy
<br /> 22. If dea.th tiaas due to external causes, fill in the following: �
<br /> (a7 Accident, suicide, or, homicide (specify)
<br /> (b) Da�e of occurrence
<br /> ( c) Where did in,jury occur:
<br /> (d) Did in,�ury occur in or about home, on farm, in industri�,l place, ln public place�'
<br /> While at work: (e) Means of in,�ury
<br /> 23. Signature C. H. Maggiore (M.D. oY other) 2�I.D.
<br /> Address Grand Island Date �igned 10/26/��
<br /> THIS CERTIFIES iHF ABOVE TO BE A TRUE COPY OF AN ORIGINAL CERTIFICATE ON FILE WTTH THE STATE
<br /> DEPARTI��IF?��T OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSIT.ORY FOR VITAL
<br /> RECORDS. ( CORP)
<br /> (SEAL) W. S. Petty. M. D. _
<br /> rector o ea an tate egistrar
<br /> Li.ncoln, Nebraska Nov 9 194�
<br /> AFFIDAVIT
<br /> STATE OF NEBRASKA )
<br /> ss Mary A. Fisher, being first duly staorn, on oath deposes and says
<br /> COUNTY OF HALL that she and Mer1 C. Fisher her lat husband ar n me
<br /> � , e , e a d ae
<br /> grantees in a warranty deed, dated March 26th, 1 �� and recorded
<br />' in the office of the Register of Deeds of Hall County, Nebraska, March 30-1�,�� in Book 97
<br /> of Deeds �,t page 62, wherein Rudolph Dohrn and Mary A. Dohrn his wife, eonveyed the Wes�
<br /> Forty (40) f eet of Lot Two (2) in Block Twenty Eight (2�) Charles Wasmer� a Addition to the
<br /> City of Grand Island, Nebraska, �o the said Mary A. Fisher and Mer1 C. Fisher, as �joint
<br /> tenants and not as tenants in common with right of surv'ivorship in the surviving grantee,
<br /> and
<br />' That she and the late P�Ierl C. F3sher, husband and wife, are named as grantees in a
<br /> warranty deed, d�,ted September 22nd. , 19�1, and recorded in the office of the Register of
<br /> Deeds of Hall County, Nebraska, Sept 29, 19�1, in Book �3 of Deeds at page �1, wherein •
<br /> J.F. Abrahamson and Gladys Abrahamson, his wife, conveyed Lot One (1) of Abrahamson's Sub-
<br /> Divi�ion of Block Forty Two ��2) , of Charles Wasmerts Second Addition to the City of Grand
<br /> Island, Nebraska, to the said M�,ry A. Fisher and Merl C. Fisher, as ,�oint tenan'�s and not
<br /> as tenants in common, with right of survivorship in the surviving grantee,
<br /> That �he said Merl C. Fisher, �rho is named as a grantee in each of the above mentioned
<br /> deeds, is one and the sazne person as Merl C. Fisher, who died at Grand Island, Nebr��ka, on
<br /> the 25th day o� .October 194�, and whase death is certiPied to in the attached cer'Gified copy
<br /> of said de�.th certificate.
<br /> Th�,t your affiant, Mary A. Fisher, is the surviving widow of the said Mer1 C. Fisher
<br /> and is the surviving grantee in each of the above mentioned deeds and that the entire f ee
<br /> simple title to each of said parcels of real estate has vested in her.
<br /> Further affiant sayeth no�.
<br /> Dated this 10�h day of November, 194�
<br /> M�,ry A. .Fisher
<br />� Subscribed and sworn to before me this 10th day of November, 19�-�
<br /> My commission expires: January 20th, 1953. Ra.y M. Hig ins,Notary Public
<br /> Filed for record this 12 day of November 19�-�, at 10t30 o' elock A.M.
<br /> ;v��� Re s er o e s �
<br /> �,,, ��...,.����.�,-
<br />
|