Laserfiche WebLink
�" <br /> �*�� <br /> I�II�CELI�ANEO�..JS �2.ECORD V <br /> � 29056-TN[A06tlfTINECO.GRIINDIlLAND,NQBR. � � �� � <br /> DEATH CERTIFICAfiE Dr. W. J. Arrasmith � <br /> . DEPARTMENT OF HEALTH <br /> Bureau of Vital Sta�3.5tics <br /> �� STANDARD C�RTIFICATE OF DEATH �792 <br /> . . <br /> DEPARTMENT OF COMMERCE <br />� ����-��� BUREAU OF TH�CENSUS � <br /> Social Security No. . . State File No. . . . . <br /> 1. PLACE OF DEATH: � <br /> (a) County Hall <br /> (b) City or town Grand Ifiland <br /> (c ) Na,me of hogpital or institution: Grand Isl.and Lutheran Hosp. <br /> (d) Length of stayt In hospital or institution Less 1 da. <br /> In this community � years <br /> 2. USUAL RESIDENCE OF DECEASED: <br /> (a) S�ate Neb. . <br /> (b) County Hall <br /> �a) Street No. 1830 W. 11 Ave. ' <br /> H-25 2 <br /> (e ) If f oreign born, how long in U. �. A.? <br /> �(a) FULL NAME Ruth A�;nes Hawkins • <br /> 3 (b) Tf �eteran, • <br /> �. Sex Female <br /> �. Co1or or r�ce White <br /> 6(a) Single, widowed, married, divorced Married , <br /> 6 (b) Name of husband or wife William F. Hawk�.r�s <br /> 6 (c ) Age of husband or wife if alive _ yrs. <br /> 7. Hirth date of deceased J<�n. 21, 1902. <br /> 8. Age ; Years Mon�hs Days �� 7_ess than one day � — <br /> � 5 lZ <br /> 9. Birthplace Sumner, Nebr. <br /> 10. Usual occupation At Home <br /> 11. Industry or business <br /> Fa�her . <br /> 12. Name John ti�J. Haase _ <br /> ' 13. Birthplaee U. S. A. <br /> Mother <br /> 11�. Maiden na,me No Record <br /> 15 . Birthplac� --------- <br /> 16. (a) �nformant ' s own signature ti►�. L. Hawkins <br /> (b,l Address arand Island, Nebr. <br /> 1''j. (a� Burial. (b) Date thereof July 5, 1946. <br /> 1�. (�. Place; buri.al or cremation Amherst, Nebr. <br /> 18. (a) �ignature o�' funeral. d3.rector Gedd�s Funeral Home <br /> (b) �ddress Grand Igland, Nebr. <br /> 19 (a) Ju1.6, 1946 <br /> Da1:e received loeal registrar) <br /> (b) F. S. White <br /> �Registrar� s Signature <br /> MEDICAL CERTIFICATION . ' <br /> 20. Da�e of death: Manth. July day 2 19�6 <br /> Zl, hour 30 a.m. <br /> 21. I hereby certify that T a�tend�d the deceased fram May 6, 1g�6 to July 2, 19�6; <br /> that I last saw her alive on July 2, 194�6: and tllat death occured on the date and <br /> hour stated above Duration <br /> Immediate cause of dea'Gh Gastric Hemorrhage 1 da <br /> Due to �errhosis of Liver 4 yrs <br /> Due to <br /> Other conditions <br /> Ma,�or f�.ndings; PHYSICIAN <br /> , of operation <br /> of autopsy Underl,3.ne the cause to <br /> which death should be <br /> - charged statistically. <br /> 22. If death were du� to external eauses, fil� in the following: ' <br /> (a), Accident, suicid�, or homicide <br /> (b) Da�e of occurenee <br /> (c} Where did in,jury occur: <br /> (d) Did in,�ury occur in or about home, on farm, in industrial place, in publie place? <br /> '�'hile at work? <br /> (e) Means of in3ury <br /> 23. Signature W. J. Arrasmith M.D. <br /> Address Grand Island Date signed 7-3-46 <br /> 25. I hereby cert�.fy I personall3� embalmed the body of the deceased named hereon. <br /> � " W. G. Geddes License No. 13�5 <br /> THIS CER�'IFIES THE ABOVE TO HE A TRUE COPY OF AN ORIGTNAL CERTIFICATE ON FILE WITH THE <br /> STATE DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY <br /> FOR VITAL RECORDS. <br /> (SEAL) Frank D. Ryder M. D. <br /> DIRECTOR OF HEALTH AND STATE REGISTRAR <br /> LINC OLN, NEBRASKA JAN 5 1g50 <br /> Fi1ed f or record this 2 day of March 1g50, at 3 :00 o� clock P.M. <br /> �� ��� �� <br /> o-o-a-o-o-o-o-c�-o-a-o-o-o-o-o-o-.o-o-o-o-o-o-o-a-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o- <br />