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������ <br /> �Isc���,��oUS R�c <br /> ORD V <br /> 29058-TX6AU60ETINECO.GRANDIBLAHD,NEBR. � <br /> STANDARD CERTIFICATE OF DEATH <br /> Dr. J. G. Woodin <br /> STATE, OF NEBRASKA <br /> DEPARTMENT (3F HEALTH <br /> D3.vision of Vital Statisties <br /> STANDARD CERTIFICATE OF DEATH <br /> DEPARTMENT OF COP�MERCE <br /> BUREAU OF THE CENSUS 5oc3.al Security No. _ S'�ate File IVo.�� <br /> 1• PLACE OF DEATH: <br /> �a) County Hall � <br /> (b) City o�' town Grand Tsland <br /> �c� Name of hospital or lnstitution:l�l� W. John -- <br /> ( d) Length af stay: In hospital or institution 3 weeks <br /> In this community lif e " <br /> 2. USUAL RESIDENCE OF DECEASED: <br /> i (a) St a'�� N ebr <br /> (b) County Ha11 <br /> (c) City o�` town Alda <br /> ( d) Stree� No <br /> x-2�5 ,�, <br /> ( e) If foreign barn, how long in U. S.A: yea,rs. <br /> 3 ta) FULL NAME Ernest Hoagland <br /> � (b) If veteran, name war � <br /> . Sex Male j <br /> 5. Color or race White <br /> 6 (a} Single, wi�dowed, married, divorced Married <br /> 6 ,(b) Name of husband or wiPe Della Hoagland <br /> 6 (c) Age of husband or wife if alive yrs. <br /> 7. Hirth date of deceased Ju1y ���`��} <br /> (�2onth) (Day) (Year) <br /> £�. AGE: Yeara Month� Days IP less �Chan one day <br /> 72 2 22 hr. min. <br /> 9. Birthplace Hall Co Nebr <br /> 10. Usua1 occupation Retired <br /> 11. Industry or business <br /> Father�l2. Name Pearl Hvagland <br /> (l�. Birthpl�,ce I11. <br /> Mo�her�l . Maiden name St�11a Campbell <br /> (15. Birthplace I11. <br /> 16. (a Informant �s own signatur� Della Hoagland <br /> (b� Address A1 da Nebr <br /> 17. (a) Bur�.al <br /> (Burial, crema�ion, or removal.) <br /> (b) Date thereof Oct 1, 1946 <br /> (c) P1ace: burial or cremation Grand Zsland, Nebr <br /> 1�. (a) Signature of funeral director GeddeS Funeral Home _ <br /> (b) Address Gran d Ssland Nebr <br /> 19. ta) oCT � 1946 <br /> (Date received 7.ocal registrar� <br /> (b) F. S. Gd'h.i t e <br /> (Registrar � s Signature) <br /> MEDICAL CERTIFICATION <br /> 20. Date af death: Month Sept �a.y 27 1946— 5 hour 45P.M. minute M. <br /> 21. I her�by certify that I attended �he deceased from Jan 2, 19�-6, to Sept 27, �g�+6; that <br /> I 1a�t saw him a13.ve on Sept 27, �.9�+6; and that death occurred on the date and hour stated <br /> above. Duration <br /> Immediate cause of dea�h Cer�bral Thrombosis 9 <br /> Due �v <br /> Ihte �Go <br /> • Other co!l�ij�tions <br /> Include pregnancy w�.thin 3 months of death PHYSTCIAN <br /> Ma�or fi�gs. Underline �he cau�e <br /> Of operations to which death <br /> Of autopsy should b� eharged <br /> stati�tically. <br /> 22. If death were due to external causeg, fill in the following: <br /> (a) Accident, suicide, or homicide � speciFy) <br /> I,� (b) Date of occurence <br />'i ( c) Where d�.d in,�ury oeeur. <br /> ty o own ounty ta e <br /> ( d) Did in,jury occur in or about home, on farm, in industrial plgce, in public place�' <br /> : (Specify type of place <br /> While at work'? . <br /> ( s) Means of in�ury ' <br /> 2�. Signature J. G. oo � n (M. D. or other) <br /> Address Grand Isl.and Date signed 9-30-�6 <br /> J. Walter Geddes L�.cense No. <br /> 173� <br /> THI5 CERTIFIES THE ABOVE TO BE A TRUE COPY OF AN ORIGINAL CEftTIFTCATE ON FILE WITH THE STATE <br /> DEPARTMENT OF HEALTH, BUREAU �F VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR VZTAL <br /> RECORDB. <br /> ( CORP),; Frank D. Ryder M.D. <br /> ( SEAL} E 0 0 AN S A E EG <br /> LINCOLN, NEBRASKA �Y 16 1950 <br /> Filed for record this 17 day of May 1950, at �F o � cloek P.M. <br /> eg � er of eed$ : <br /> 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-o-o-o-o-o-o-o-o_o-o-o-o <br />