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`�7� S RECORD V
<br /> NIISCEI�I�AN�OU
<br /> 29058-TNEIIU6Uti1NECO.ORANDISLAND.NEBR. �
<br /> 2. UStTAL RESSDENGE (Where deaeased l�.ved. If inatltution: residence bePore admission) . .
<br /> a. STATE Nebr
<br /> b. C�UNTY Hall -
<br /> e. GITY (IP outside eorporat� limits, write RURAL)
<br /> �R Grand Ialand, Aural
<br /> T�WN �
<br /> d. STRRET (�f rural, give Iocation) �
<br /> ADD�ffESS �.W. City 1 mile -
<br /> 3. NAME OF DECEA9ED a. (First) b. (Middle) o. (Last)
<br /> (T3rpe or Print) Amanda EI1en Huf t9�nan � '
<br /> �-. DATE (Month) (Day) (Yea�� �
<br /> �F Apr. 24- 19�9
<br /> �EATH
<br /> 5. BEX Fema,l e .
<br /> b. COLOR or RACE White
<br /> 7. MARRIED, NEVER MARRIED, WIDOWED, DIV�RCED (Speeify) Married
<br /> �. DATE OF BTRTH Jan 27, 1�65 � �
<br />' 9. Age (In yra. last birthday) �1-- If Under 1 Yr. If Under 2� Hrs. � "
<br /> Mos.: Days Hours Mia. -
<br /> 10�,. USUAL �CCUPATT�N (Give kind c�P work done during most of working 11fe, e�en if rettred)
<br /> At Home • � .
<br /> l�b. RIND OF BEJSSNE3S �R INDUSTRY
<br /> 11. BIRTHPLACE (City, �Gown or county) S�ate of foreign Qountry)
<br /> G�ienoa Ill � -
<br /> l2. CTTI2EN �F �iTHAT C�UNTRY: U.3. -
<br /> I�• FATHER�B �ITAME J�W�Carmichael
<br /> 1 a. MOTHER'S I�IAIDEN NAME Anna Sa.yer � _
<br /> 14b. NA1�E ��iUSBAND �R WI�'E Elmer A. HufPman
<br /> I�j. WAS DEC SED EVER IN U.S. ARMED FORCES:
<br /> (Yes, no, or unknown) (IP yes, give war or datea af service)
<br /> . No
<br /> 16. soezat► s�cu����t �to. �
<br /> 17. INF�RM�iiNT� S NAME or Si�nature �C Address E1m�r A. Huffman,Grand Island, Nebr
<br /> 1�. CAtTSE OF DEATH �IEDICAL CERTIFICATIOI� Tn�erval Between (
<br /> Enter or►ly one cause per I. .DISEA�E OR CONDITI0�1 �naet and Dea�h
<br /> line for (a), (b) , and ( c) DIREC�LY LEADII�G TO DEATH�
<br /> (a) Corona,ry Thromboai� 3 hra.
<br /> '�This dves nat mean the mode ANTEGEDENT CAUSES
<br /> of dying, sueh as heart gailure, DtTE T� (b) Arterio sclerosis
<br /> asthenia, ete. T� means the eordiovacular disease 20 yrs.
<br /> disease, in,�ury, or eamplica- Morbid eondit�on�, if anq, gieing rise
<br /> tion which caused death. to the a,bov� cauee (a) �tatin� the .
<br /> underlying cause last.
<br /> DUE T� (c) Arterio sclervsis, �
<br /> "II. �THER SIGNIFICANT CONI?TTZ�IVS �eneral " 30 yrs.
<br /> Conditiona eontrib�tin� to the �death bu� no� �
<br /> related to the disease or Qondition cauaing death.
<br /> Cerebral arterio sclerosis -
<br /> 19a. DATE OF OPERATION
<br /> 19b. MAJOR FINDTNGS fJF OPERATZQN
<br /> 20. AUTOPSY: Yes No X �
<br /> 21a. ACCIDENT (Specit�
<br /> stTICIDE
<br /> H�MICIDE
<br /> 21b. PLACE OF TNJUAY (e.g. , in or a,bout hame, Parm, Pactory, atreet, office bldg. , etc. )�
<br /> 21e. (CZTY �R TOWN) (�OUNTY} (STATE)
<br /> (If rural area, write RURAL)
<br /> 2 ld. TIME �Month) (Day} (Year) (Hour)
<br /> OF m. -
<br /> INJtJAY -
<br /> 21e. INJURY OCCi7RRED -
<br /> Whi�e at �fork
<br /> No t Whil e at o�r `�`�
<br /> 21f. HOW DID II�JURY OC�:�`- �
<br /> 2�. I hereby certffy �ha� I attended the deeeased from Jan. 31, 194g, to April 24, ���F9,
<br /> that I last saw deeeased alive on April 22, 19�-9, and that death oceurred at l4— A.M. ,
<br /> from the cau5es and on the dat� stated above. �
<br /> 23a. SIGN'ATUAE W. H. HombacY�, Jr. M.D. -
<br /> 23b. ADDRESS arand I81and, Nebr.
<br /> 2 e. DATE 3IGNED 4-26-4g
<br /> 2�a. BURIAL, CRII�A.TION, REMOVAL (Specify) -
<br /> Burial
<br /> 24b. DATE Feb 2�/49
<br /> 24c. NAME OF CEMETERY OR CREMATORY Cedar View
<br /> 2�+a. L�CATI�I� (ci�y, �o�n, or coun�y) (state) ,
<br /> Doniphan, Nebr--
<br /> DATE REC�D BY L�CAL REG. MAY 2-19�9
<br /> REQ-ISTRAR'S SIGNATURE F. S. Whit�
<br /> 25. FUNERAL DIAECT08�S SZQI�ATURE ADDRE83
<br /> Geddea �'uneral Home arand Island, Neb�. .
<br /> TO HE ACCONIPLISHED WHEAT BODY IS Ei�BALMED
<br /> 25. I hereby certify I personally embalmed the body of the deceased named her�on.
<br /> Sr�in H. P�te�son Licenae No. 1�26
<br /> �
<br /> THIS CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN �RIaINAL CERTIFICATE OP� FILE �dITH THE STATE
<br /> DEPARTMENT �F HEALTH, HUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEP05IT0RY F�R VITAG
<br /> RECORDB.
<br /> ( CORP) Frank D. Ryder M.D. �
<br /> ( SEAL) D E � �F ALT AN 8 A E Ea S
<br /> LINCOLN, �tEBRASxA_ 1�� 29 1950
<br /> Filed for record this 31 day of March 1950, at 2:45 0'cloak P.M, C��►�✓ ♦ I
<br /> . egis er of eeds �,
<br /> o-o-o-o-o-o-o-o-o-o-o-o-o-o-�-o-o-o-o-o-o-o-�-o_o-o-o-o-o-o_o-o_o-o-o-o-o-o-o-o-o-o�-o-o-o_o I
<br />. . _�_ -, - _,�_ __ _
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