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_ - _ _ <br /> I <br /> � <br /> t��"� <br /> I�II�C�I�LAN�OUS �.�CORD V <br /> 29068-TN[AOOOfTINECO.CMND14MND,1168R. � � � . � . . . �-�� <br /> CERTIFICATE OF DEATH <br /> MTNIVESOTA DEPAATMENT 4F HEALTH <br /> Division of Vital Sta�istScs <br /> CERTTFICATE OF DEATH REGI3TERED N0. 2�0 <br /> 1. PLACE OF DEATH: STATE OF MIIJNES�TA <br /> a. C�UNTY Olmsted <br /> b. TOWNSHIP <br /> DR <br /> e. CITY 4R VILLAGE Rochester <br /> d. PdAME OF (TY not in hospital or institution, give s�reet address or location) <br /> HOSPITAL OA <br /> INSTITUTION Worrall Hospital <br /> e. LE�TaTH OF STAY (in this dis trict) 6 da.ys <br /> � 2. UBUAL RE9IDENGL (Where deceased lived. If institution: residenee before adnlission. ) <br /> ' a. 3TATE I�eb�ask�, b. COUNT'Y <br /> e. TOWNSHIP <br /> OR arand Island <br /> d. �ITY 4R VILLA(�E Is residence within it� corporate limi�s: YES NO <br /> arand Island, Nebraska 247-S.Sycamore �` - <br /> �e. P. �. ADDRE39 ST. <br /> 3. NAME OF DE�EASED a. (�'irat) b. (Middle) c. (Last) <br /> Julius Conrad A. Erlandson <br /> �. DATE OF DEATH (Month) . (Day) (Year) <br /> 5. sEX Male 3 13 1950 <br /> 6. COLOR DR RACE Whi�e <br />_ 7. MARRIED, NEVER NIARRIED, WIDOWED, DIV�RCED (Bpeeify� Married <br /> �. DATE OF' BIRTH Apr11 25a 19�9 <br /> 9. AQE (In �ears last b�.rthday) 4t) If Under 1 Year <br /> Months Days <br /> 10a. USUAL OCCUPATION (Give kind aP work done durin� most of wo�king life, even iP retire�) <br /> Llthogr�,ph operstor <br /> lOb. KIND OF BU�INESS OR INDUSTRY Au�stive Printing Co. <br /> 11. BIATHPLACE (Sta�e a� forei�n country)- North Da,knta <br /> 12. CITIZEN OF WHAT COUNTRY: U.3.A. , <br /> 13. FATHER�B NAME Even Erlandson <br /> 13b. MOTHER�B MAIDEN NAME Caroline Mar�in <br /> 1��. 3POUSE�S NAME Marie Mtirphy <br /> 15. S�AS DECEASED EV'ER IN tT.S. ARMED FO�tCEB: <br /> (Yes, no, o� unknown) �es It' yes, give war Qr dates oP service) World War II <br /> 16. 3�CIAL SECI:IRITY N�. <br /> 17. IN'FORMANT�S OWN SIGNATURE ADDRE38 <br /> W. A. Bennett Roehester <br /> Mayo Clinic Records Minnesota <br /> Z�. Enter only one MEDICAL CERTIF'ICATTON <br /> cause on lines 1. DI3EASE 4R CONDITION T��E BETyPEEN <br /> (a), (b) �.nd (c). LEADING DIRECTY TO DEATH�(a� Pulmonaxy edema ON3ET & DEATH <br /> # ve disease,' in- <br /> �ury or compli�ation TO (b) Uremia-cauae (:) <br /> whieh waa the TMMEDIATE <br /> CAUSE o�' death, nnt mode Dt7E TO (c) <br /> oP dying, as hear failure, 2� OTHER SIGNTFICANT CONDITIOh19 <br /> ssphyxia, etc. <br /> Contributing to death but not <br /> related to disease or� condi�ion <br /> causing dea�h. <br /> 19a. DATE OF �PERATION -.- <br /> 19b. MAJOR FIATDINGS OF OPERATION -- <br /> 20. AUTOPSY: YES NO <br /> 21a. AQCIDEN'T (Speci�'y'j�'� <br /> SUICIDE <br /> H�MI�IDE <br /> 21b. PLACE OF ZNJURY (e.g. , in or about home, farmt Paetory, street, office bldg. . etc. � <br /> 21e. �CITY, V'ILLAQE OR TOWNSHIP) (CDUNT'Yj (STATE) <br /> 21d. T2ME OF IN�'URY (Month) (Day) (Year) (Hour� �n. <br /> 21e. INJURY OCGtJRRED <br /> While at Wor& �Tot While At Work <br /> 21f. HOW DID TNJtJ1�Y�'�UR. <br /> 22. I hereby cer�ify tha� I attended th� dec�eased from Maresh 7, 1950, to March 13, 1950, <br /> that I last saw the de�eased alive on l��,rch 13, 1950, and that death ocourred a'� <br /> �j:�5 p.M. , t'rom the causes and on the date stated above. <br /> � 23a. 9IQP�ATURE - � <br /> W.1�.Bennett, M.D. (Degree or title) <br /> In/ for the Mayo Clinie <br /> 23b. ADDRESS <br /> Roehester Minnesota <br /> 23e. DATE SIQ�NED � <br /> 3-13-50 � , <br /> 2�a. BURTAL, CREMA2ION <br /> ��+IAUAL (Specify) <br /> 2�-b. DATE+`� <br /> 3-14-50 <br /> 240. NAME OF CEMETERY DR CREI�ATORY -� <br /> 2�Fd. L4CATIDId (Qity, villa�e or eoun�y) (State) <br /> Grand Island, N�b. <br /> DATE FILED BY LOCAI, REG. 3-1�j-50 <br /> RE�I3TRAR�3 STGNATURE Vi��or O. �lilson <br /> �5. 3IGNATtJRE OF FUNERAL DTRECT�R �A ENiBALMER A�DRESS <br /> E.L. Haxkness, Rocb.est�r, Minn. <br />