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<br /> IUIISCELL.AN�OUS RECORD V
<br /> 29058-THE11UGtl5TINEC0.GR11NDISLAND,NlBR. � � �
<br /> 1�. CAUSE OF DEATH MEDICAL CERTIFICATION
<br /> I. DI3EASE OR CONDITION DIRECTLY LE�tD2NG TO DEATH (a) Myocarditis, chroim
<br /> DUE TO (b)
<br /> DUE T� (c)
<br /> II.OTHER SIGNSFICANT CONDZTIOI�S
<br /> 19a, DATE OF OPERATION
<br /> l�b. NIAJOR FTNDINGS OF OPERATION
<br /> 20. AUTOPSY: Ye� No x
<br /> 21a. ACCIDENT SUICIDE HOMICIDE (Specify)
<br /> 21b. PLACE OF INJURY -
<br /> 21c. (CITY OR TOWN) ( C�UNTY) (STATE)
<br /> 21d. TIME OF I1�JURY (Month) (Day) (Year) (Hour) m.
<br /> Ql�. IN�7URY OCCURRED
<br /> While at Work
<br /> Not Whi1e a� Work -
<br /> 21f. HOW DID INJURY OCCCTR:
<br /> 22. I hereby certify that I attended the deceased from 9-5, 19�6, to 5-2�, 1949, �hat I
<br /> last saw deceased alive on 5-27, 19�-9, and that death occurrred at �-: 56 P.m. , from
<br /> the eauses and on the date stated above.
<br /> 23a. SIGNATURE K. F. MeDermott M. D.
<br /> 23b. ADDRESS Grand Island, Nebr.
<br /> 2�e. DATE SIGNED 5-31-�9
<br /> 2 a. B�IAL, CREMATION, REMOVAL (Specify) Burial
<br /> 2�b. DA�E 5-31-�9
<br /> 2�-c. NA1�SE dF CENiETERY �R� CREMATORY Gra.nd Island,
<br /> 24d. LOCATIOId � City, '�own, or cou�ity) (Sta�e)
<br /> Grand Tsland, Nebr.
<br /> DATE REC�D BY LOCAL REG. JUN 9-1949
<br /> I REGISTRAR'S SIGNATURE F. S. White
<br /> 2 . FUNERAL DIRECTOR�S SIGNATURE ADDRESS '
<br /> 5
<br /> Livingston-Sondermann, Qrand Island TO BE ACCOMPLISHED WHEN BODY IS EMBALMED
<br /> 25. I hereby cer'�ify I personally embalmed the body of the deceased named 'nereon.
<br /> • o.
<br /> THI5 CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL CERTIFICATE ON FILE WITH THE 1�20
<br /> STATE DEPARTMENT OF HEALTH. BtJREAU OF VITAL STATTSTTCS� WHICH IS THE LEGAL DEPOSITORY
<br /> FOR VITAL RECORD�3.
<br /> ('CORP) W. S. Petty. M. D
<br /> (SEAL) IRECTO OF HEAL AND A E RE IS
<br /> LZNCOLN, NEBRASKA JUN 10 1949
<br /> STATE OF NEBRASKA )
<br /> �
<br /> COiTNTY �F HALL ) sa AFFIDAVI2. .
<br /> Loretta J. Hathaway, being firat duly sworn, on oath depose5 and says that she is th�
<br /> surviving widow of James E. Hathaway, who died at Grand Ialand, Nebraska vn Ma.y 2�th, 1.9�+9
<br /> and that he is the person mentioned in the attaehed certi�ied eopy of certifieate of death
<br /> o� James Ellsworth Hathaway, and that he is one and the same person as the James �. Ha�hawa,y
<br /> wh:o in mentioned as grantee in a warranty deed, dated and acknowledged, Mareh �th, 1g41 and
<br /> recor�ed Mareh loth ig�+l in B�ok �1, page �472 of deeds in the Office of the Regis'�er of
<br /> d�eds of Hall county, Nebraska, wherein M. Dee Koch and E: z�ias Koch, husb�.nd and wife, each
<br /> in �heir own right, conveyed,
<br /> Lot Ten (10) Block Thirty One (�1) , Russel ti�h.eeler �s Addition to the �ity of Grand
<br />' Island, PSebraska, to
<br />� James E. Hathaway and Lore�ta J. Hathaway, as ,�oint tenants and not as tenants in
<br /> common, it being the inten'�ion of �.11 parties there'Go that in the event of the dea'�h of
<br /> either of' sa,id grantees, �he entire �'ee simple title to �he real estate descxibed Yierein,
<br /> shall vest in the surviving grantee,
<br /> That your affiant, Loretta J. Hathaway, is the same person as Loretta J. Hathaway
<br /> mentioned in said deed and is the surviving grantee ancl the entire ��ee simple 'Git1e ta
<br /> �aid real estate herein described, has vested in her.
<br /> Witness my hand this 14 day of June, 19�+9 �
<br /> Loretta, J. , Hathaway �
<br /> Subscribed and sworn to before me this l� day o�' June, 19�+9•
<br /> �SEAL� . Ra�M. Hig ins
<br /> Comrnission Expires Jan 20, z953 �o ar�y�ubi�c
<br /> Filed for record this 14 day of June 19�+9, at 3:30 0 �clock P.I�. -
<br /> � ��� -
<br /> Reg � er vf DeedB
<br /> 0-0-0-0-0-Q-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-�-�-0-0-0-0
<br /> LIS PENDENS �
<br /> IN THE DISTRICT COURT OF HALL COUNTY, NE�ASKA
<br /> 2'HE C OUNTY' OF HALL, � Case No. 13. Docket 1 Pa,ge "
<br /> PLAINTTFF, � � -
<br /> -VS- � NOTIGE OF LIS PENDENS
<br /> MINNSE W. IAMS, w�.dow, et a1s. , � -
<br /> DEFENDANT, �
<br /> T 0 WHOM I�' MAY C ON�ERN:
<br /> You are hereby no�3.fied that on the 16th day of June, 1g�9, the Coun'�y of Hall� State
<br /> of Nebraska, fil�d its petition in the above entitled ease in the Dis�rict Court of Hall
<br /> County, Nebraska, con�isting of Ten Causes of Action against the defendants named in sa3.d
<br /> Petition, ec�neerning the real estate in said Cause of Action hereinafter set forth�
<br />
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