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<br /> I�IISC�LLANEOUS RECORD V
<br /> 29058-TN[IIUfiU{TINECO.G811NDIfLAND.NEBP.
<br /> aet and deed. Witness my hand and notaria3 seal, �he da�e last a�'oresaid.
<br /> (SEAL) Lucile J. Lukeeh,
<br /> l�ota.ry Public
<br /> My commi�sion expires on tY�e 15th day of July, �.955
<br /> NEBRASKA
<br /> �ta�e of l�ebraeka, )ss. .
<br /> �toun�y of HaI.3, ) On this 12th day of �ctober, 19�g, be�ore me a notary puhli� 3,n
<br /> and for sa,ld aounty personally came the abae� named Charles E. �
<br /> Taylor Jr. who is personally known �o me to be th� ident3aal p�rson whose name is affixed
<br /> to the above ina�rumen� as grantor �,nd he acknowledged �a1d instrument to be his
<br /> vol�.ntary act and deed.. Witnese my hand and notaria,l seal, the date last aToresaid.
<br /> (SEAL) - . Lucile J. Lu�esh, ,
<br /> . Notary Publie ,
<br /> My commi�sion expires on the 15th day of July, 19�,�. �
<br /> _ ,
<br /> NEBRASKA -
<br /> S�ate of Nebraska, }ss. ' ' .
<br /> �ounty of Lancaster ) On this 3.�$ day of October, 1g�9� b�fore me �a, no�ary public
<br /> in and f or �aid eo�znty persona,l�y came the abov� named Ernest
<br /> FrSseh State Dlrec�or, F H A who is personai.ly known �o me t,o be the iden�ical person
<br /> whose name ie affixed to the above instr�ument as grantor and h� a�knowl�dged �aSd .
<br /> ir��trument to be his voluntary act and d�ed. Witness my hand and notar.ial �eal, the
<br /> da�e last aforesaid. ,
<br /> .
<br /> (SEAL) - Helen Ar�th
<br /> _ Notary Public
<br />'' - I�.y commisBion .exp3.res on the 12 day of J'une, 19,52
<br />', Filed for record thi� 1 day of November �.9�9, at 1:�5 ot�loak F.M.
<br /> ��.,�, .G��
<br /> REGISTER OF DEED� � �
<br /> �-0-�-fl-0-�-4-0-0-0-{?-►0-0-4-4--�-0-0-('�0-0-0-0--�-0-0-p-0-��0-f�-0-Q-0-Q-0-t)--C)-fJ-0-0-0-0-0--
<br /> gTANDARD CERTIFS�AT� OF DEATH
<br /> I'� . NEBRASKA (5TATE) DEPARTME�TT OF HEALTH
<br /> Bureau of Vita]. �ta�istids
<br /> STAND�RI9 CEATIFTCATE OF DEATH
<br /> F�DERA.L �ECt7RITY AGEI�CY 9'7�0
<br /> U. 3, PUBLTC HEALTH 3ERVICE
<br /> National Office of Vita1 Statistics
<br /> �loeial Securi�y No, 8tate File No,
<br /> PLACE OF I)EATH:
<br /> (a) County Hall
<br /> (b} �ity or totan Grand Island
<br /> (c) A1ame of hoap3tal or Snst�.tution: 636 W. 6th
<br /> (d) Length of stay; Tn hoepital or institution
<br /> in th3s community 28 yeare
<br /> 2. USUAL RESIDE�ICE OF DE��ASED;
<br /> (a) State �iebraska
<br /> (b) c�ou�ty x�.i
<br /> (c) Gity or town Grand Ieland -
<br /> 6
<br /> (d) Street No. 16 W. 6�h
<br /> H- '2
<br /> 55
<br />, (e) I�' Pore h born how loM in U. 8. A.? ears.
<br /> � , � Y
<br /> 3�a) FULL NAME Ghristia� F. Ha.nsen
<br /> 3(b) If ve�eran,
<br /> na.me war -
<br /> �. �ex A�ale
<br /> 5. Color o� race whi�e
<br /> 6(a) Single, w3.dowed, marrisd, �ivorced marri�d
<br /> 6(b) Name oP husband or wiPe Wilhelmina Hariaen
<br /> 6(a) A�e of huaband or w3.fe if alive 5,� yrs.
<br /> 7. Birth date of deceased June ].8 1888 �
<br /> (Mont t�`ay-�Y`ear)
<br /> 8. Ag e: year� Months Days
<br /> 60 � �
<br /> 9. BirthplaQe Chaee County GoZorado
<br /> 10. Usual occupation retired mail-carrier
<br /> ll. Zndustry or bus�.ness Pogtal Service
<br /> Father (12. Name Peter Hansen
<br /> (33. Birthplace Hols�eln, Germany
<br /> MotMer (14�. Name Sophl.e Doll
<br /> (15. B�.rthplace Grand I�land �Tebraeka
<br /> 16. �a) Informan'G� s own eigna�ure Mrs. (3. F. Hansen
<br /> (b) Addres� arand Isla�d, N�br.
<br /> l�. (a) Burial (b) Date thereof 10-�.�-�8
<br /> (c) Place; burial or crema,�ion arand Island, Nebr. -
<br /> 18. (a.) Si�na�ure o� funeral director Livingston-�ondermann �
<br /> (b) Addresa GFrarid I�land, Mebr. '
<br /> i9. (a) (Date reeeived lo�al �►�glstrar) �TOV. � - 19�8
<br /> (b) (Reglatrar� s Bignature) F. 3. 'ti�hite
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