|
L�'��
<br /> I�IISCELLANEOUS �2ECQRD V
<br /> 290E8-TNiAUiUtTINECO.ORABDtlLAND.N[6R. , . � � . . �
<br /> Nebraska and has been for more '�han th3.rty (30) years last pas'�; that he was well and
<br /> personally acquainted with Jennie Drake, one of the Grantees in Warranty Deed recorded in
<br /> Book 62 a� Page 63 of the Deed Records of Ha11 County, Nebraska, and with Jennie M. Drak�,
<br /> one of the Grantors in Warran�y Deed recor ded 3.n Book 62 at Page 696 0�' the Dead Recorda
<br /> af Hall County, Nebraska; and that afPiant know� of his own personal knowledge that the
<br /> said Jennie Drak.e and Jennie M. Drake are one and the same person, nowithstanding the
<br /> discrepancy in names.
<br /> And further affiant sayeth not.
<br /> C. T. Flower
<br /> Subscribed in my presence and sworn to before me th3.s 4�h day of August, A.D. lg�+g.
<br /> (SEAL) Ruth E. Ahlc�uis�t��_
<br /> My commission expires Deeember �-th, 1951 �t "ota-ry�u'G ��e
<br /> Fi1ed for record this 26 da.y o�' August 1g49, at 10:15 o �elack A.M.
<br /> �
<br /> eg ster of Deeds
<br /> 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_0_0-0-0-0-0-0-0'�
<br /> STATE OF NEBRASKA
<br /> DEPARTMENT OF HEALTH
<br /> Bureau of _ �'�.�a1 - ��a�i�t�.S�'_
<br /> ����H_A�0. .126. . . CERTTFICATE OF DEATH 8'���E FILE N0.
<br /> PLACE OF DEA`TH .:_ . . _ _ _ �
<br /> li:. • . - . - .. .
<br /> a. COUNTY Hall _
<br /> .. ,
<br /> � C€rar�c� ;Is1�d.- � - ^ . _, - _ . .,
<br /> b-.� C►�'��' �R T OWN � c�
<br /> ��r � 5���1��k �U�'� £�TAY-- (in-�� ���.�� ���:�e3 �� � '� ��:�y' � -_ � -. � �Tf �not in hospital or
<br /> d. FULL NAME OF H�SPTTAL� OR TNSTITUTTON Luthera�i Ho�pital (in5�it��ion, give atreet
<br /> (address or location)
<br /> 2. USUAL RESIDENCE (Where deceased I.ived. If Tnstitution; residence before admisaion).
<br /> a. STATE Nebraska
<br /> b. C OUNTY Ha17.
<br /> e. CITY QR TOWN Grand Ssland
<br /> d. STASET ADDRESS �04, East 8th 5�reet
<br /> 3. NAME OF DECEASED Alva Julia Morrow
<br /> �. DATE OF DEl�TH July 8, 19�9
<br /> �. S�'X Fema1E
<br /> 6. r;�OLOR or RACE whi.te
<br /> '�. MAR.R.IED, NEVER MAR.R.IED, WIDOWED, DTVORK�ED Widowed
<br /> 8. DATE OF B2RTH 12-g-].858
<br /> 9. Age (In yrs. last birthday) �0- �f Under l Yr. Mos. 6 Days 29 If Under 2� Hrs.
<br /> 10a. USUAL OCCUPATION (Give kind of work done during most of working life, even if retired)
<br /> Housew�.f e
<br /> 10b. KTND 0�' BUSINESS OR INDUSTRY Home
<br /> 11. BIRTHPLACE Petersburg, T11.
<br /> 12. CI�IZEN OF WHAT COUNTRY? t7. S.
<br /> l3. FATHER� S NAME Andr�w J. Butterton
<br /> l�a. MOTHERt 5 MASDEN NAME El�za =�--�-
<br />• l�b. NAME OF HUSHAND OR WTFE Andrew J. Morrow
<br /> 1�. WA� DECEASED EVER TN U. S. ARMED FORCES? no
<br /> ld. 50CTAL SECURTTY N0. none
<br /> 17. INFORMAT ' S NAME or Signature & Address Mrs. Eva Stock, Grand Island ,
<br /> 18. CAUSE OF DEATH MEDICAL CERTIFICATION
<br /> �.,� D�SEASE OR CONDITION DIRECTLY LEADING TO DEATH (a) Ca.�.c�r, bowel
<br /> Inter�a,l Between Onset and Death 1 y DUE TO (b)
<br /> AY�I'�ECEDENT CAUSES,
<br /> DUE TO (e)
<br /> II. OTHER SIGNTFICANT COUNDITIONS
<br /> �9g,�•-DATE OF OPERATION -
<br /> 19b. �AJOR F'TNDINGS OF O�ERA2'ION
<br /> �Q. AU�'OP SY? �
<br /> 21a. ACCZ��NT SUICIDE HOMIl�IDE
<br /> 21b. PLACE OF INJURY
<br /> 21c. (CTTY OR TOWN - - ( C10UNTY) (STATE)
<br /> 21d. TIME OF INJURY
<br /> 2�;e. INJURY OCCURED
<br /> 2�.f. HOW DID TNJURY OCCUR?
<br /> 22. I hereby certify tha� I attended �he dec�eeased from June 19�9, �o Ju].y,8, 1949, tha�
<br /> I last �,�,w deceasEd alive on July 8� 19�'9, and that death occured at 9 P m. , from the
<br /> Ca,U3E8 and on �Che date stated above
<br /> 23a. SIGNATURE J. G, Woodin, M.D.
<br /> 23b ADDRESS Grand Island
<br /> 23c. �ATE SIGNED '�-9-�9
<br /> 24�a. BUR21�L, CREMATION, REMOVAL Suriel
<br /> z4�b. DATE '�-ZZ-19�9
<br /> 2�yc. NAME OF CEMETERY OR CREI'�iTORY Grand I sland
<br /> 2�d. LOCATION Grand Island, Nebr.
<br /> DATE REC'D BY LOCAL REG, JUL l� 19�9
<br /> REGIS�'RAR' S SIGNATURE F. S. White "
<br /> 2,$. FUNERA.L DIRECT4R� S SIGNATURE Livin�ston-Sondermann, Grand Island
<br /> 2 . I hereb certif I ersonall embalmed the bod of the deceased named hereon.
<br /> Peter J. Merten License No. 1 20
<br /> THI� CERTIFIES THE ABOVE TO BE A '�RUE �OPY OF AN ORIGINAL �ERTIFICATE ON FILE WITH THE
<br /> STATE DEPARTI�IENT OF HEALTH, BUREAU OF VITAL STATTSTICS, WHTCH IS THE LEGAL DEPOSITORY FOR
<br /> VITAL RECORDS.
<br /> (CORP) W. 8. Petty. M. D. _
<br /> (SEAL) DIRE�TOR OF HEALTH AND STATE REGISTRARAR
<br /> LINCOLN, NEBRASKA AUG 22, 1949
<br /> Filed f or record thia 26 day of Augu�t 19�9, at 2:30 o�cloek P.M.
<br /> F���.G�'�-��,. �!�'` '
<br /> a'�~6�-��'
<br /> --__ _--J
<br />
|