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<br /> 1vIISCELLANEOUS R�CORD V
<br /> 29088-TH6Atl6tlfT1I1FCO.ORANDI8L11ND.NFBR. . .. . . . . . � . �
<br /> �. ATA�IE OF DECEASED a. (First) b. (Middle) a. (Las�)
<br /> Type or Print) Elmer Albert Huffman .
<br /> 4. DATE (Month) (Day) (Year)
<br /> OF June 1�, 1949 .
<br /> DEATH
<br /> �. 8EX Male
<br /> 6. C�LOR or RACE Wh3ts
<br /> 7. MARRIED, I�EVER MARRTED, V�IDOWED, DIV4RCED {Specify) Widower
<br /> �. DATE OF BIRTH J�.ne 2, 1�62
<br /> 9. Age (In yrs. last birthday 87 If Under 1 Yr. If Under 2�+ Hra
<br /> • Mos. Days Hours Min.
<br /> l�a. USUAL OCCUPATTON (G3ve kind of wc�rk don� during most oP �aorking liPe, even if retired)
<br /> Retired Farmer
<br /> 10b. KIND OF BUSI�IESS OR INDU�3TRY
<br /> ll. BIRTHPLACE (Ci�y, �vwn or county) fSta�e of foreign aountry)
<br /> Smyrna Iowa
<br /> 12. CITIZEN OF V�iAT C�UNTRY�' U. S.
<br /> 13. F�THER�3 A1A�4E No Re�or d
<br /> 1F�s. Ni�THER'S NIAIDEN NAM� No Record
<br /> l�b. NAME OF HT7SBAND OR WIFE Amanda Ellen HufPman
<br /> 15. WA►3 DECEASED EVER IN U. S� ARMED FORCE3:
<br /> (Yes, no, or unknown) ( If yes, give war or dates oP service)
<br /> No _ _
<br /> 16. SOCIAL BECURITY N0.
<br /> 17. INFORMANT�B NAME or S3.gnature & Address Earl Huffman, .Grand Island Nebr
<br /> 1�. f�AUBE 0�' DEATH MEDICAL CERTIFICATI�N . In�erval Between
<br /> Enter only one �ause per I. DISEASE OR CONDITION Onset and Death
<br /> line for (a) , (b) , and (�) DIRECTLY LEADZNG T� DEATH.�
<br /> �a) Cerebral Thrombosis � hours .
<br /> `This does not mean the mode ANTECEDENT CAUSEs
<br /> of dying, auah a� heart DUE TO (b) Cerebral Arterio 3� yrs.
<br /> P�,ilare, asthenia, etc. It �cl�roaic�
<br /> means the disease, in�ury, Morbid conditions, iP any, giving rise
<br /> or eomplieation �hich ca,used to the above �ause (a) stating the
<br /> death. underlying cause last. -
<br /> DUE TO (cs) '
<br /> �II. OTHER SIGNIF=ICANT CONDITIONS
<br /> Conditiona contributing �o the death but Mot
<br /> related �o the disease or condition causing death.
<br /> 19a. DATE �P' OPERATI01� "
<br /> 19b. MAJ�R FINDINGS OF OPERATI��1
<br /> 20. AUTOPBY: Yes No x
<br /> 23a. ACCIDENT (S�aify�
<br /> SUICSDE
<br /> � HOMICI�E
<br /> 21b. PLACE OF SIJJURY (e.g. , in or about Yiome, Parm, Paetory, street, oPfiee b1dg. , ete. )
<br /> 21c. (CSTY �R TOWN) ( COUNTY) (STATE)
<br /> ( If rural area, write RURAL)
<br /> 21d. TIME (Mvn�h) (D�y) (Year) (Hour)
<br /> OF m.
<br /> INJURY
<br /> 21e. INJURY OGCURRED
<br /> While at Work
<br /> Not While at or
<br /> 21P. HOW DZD INJURY OCC�
<br /> 2C. I h�reby certify that I attended the deceased from June 17, 19�+9, to June 1�, 19�+9
<br /> that I last �aw deceaeed alive on June 17 19�9, and that death o�eurred a�G 5g4 A.�n. ,
<br /> from the causes and on the d�.te sta�ed above.
<br /> 23a. SIGNATURE W. H. Hombach, Jr. M.D.
<br /> 2�b. ADDRESS 4rand Island, Nebr
<br /> 23c. DATE SIGNED 6-2�-49
<br /> , 2�1�a. BURTAL, CREMA ION, REMOVAL (Speeify) Burial
<br /> 24b.. DATE June 21�49 "
<br /> 24a, NAA�IE OF CEMETERY OR CREMATORY Cedar View
<br /> 24d. LOCATION (City, town, or count�) (State)
<br /> Doniphan Nebr
<br /> DATE AEC'D BY I,OCAL RE4 Jur� 22 19�+9
<br /> RE(�TSTRAR�S SIGNATUR� F. 3. White
<br /> 25. FUNERAL DIRECTOR�S SIGAiATURE ADDAESS
<br /> Geddes Funeral Home Grand Island Nebr
<br /> TO BE ACCOMPLISHED WHEN BODY IS EMBALMED
<br /> 25. I hereby Qert3Py T personally embalmed the body of the demeased��.named hereon.
<br /> Da.mon J. Nielsen License No. 15�5
<br /> THIS CFrRTIFIEB THE AB�VE T� BE A TRUE COPY OF AAT �RIQINAL CERTSFIeATE ON FILE WITH THE
<br /> STATE DEPARTMENT �F HEALTH, BUREAtJ' OF VITAL STATISTICS, WHICH IS THE LEf�AL bEPOSITORY FOR
<br /> � VITAL RECORDS.
<br /> �C��'� Frank D. R der M.D.
<br /> (9EAL) D RE T0 OF HEAL H AND S E IS
<br /> LINC�LN, NEBRASRA MAR 2�,L195o
<br /> PHS-79� (VS) R�V. �+-� I?r. W. H. Hombach Jr.
<br /> F'EDERAL SECURITY AQENCY STATE OF' NEBRA3KA
<br /> PUBLIC HEALTH 3ERnICE DEPARTA��NT OF HEALTH
<br /> Bure�u� of Pital Statistics
<br /> BIATH N0. 126 CERTIFIGATE �F DEATH STATE FILE NQ: �037�j1
<br /> 1. PLACE OF DEATH
<br /> a. coUr��c xail x-i55
<br /> b. CITY (If outsid@ corporate lim3.ts, write Rural)
<br /> 4R arand Island
<br /> �'4WN
<br /> c. LENGTH OF STAY (in this plsee) 5 yrs--
<br /> d. FULL 1VAME OF ' (If not in .nospital or institution, �ive s�ree� address or location)
<br /> H03PITAL OR� 51b N. Sqcamore S�G
<br /> TNSTITUTIO�i
<br /> .�
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