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<br /> � � I�IISCEI�LANEOUS R�CORD W
<br />, 99289�-THE�UGU4TINlCO.GRANDISLAND,NEBR. � �
<br /> DEATH CERTIFICATE
<br /> NEBRASKA STATE DEPARTMEATT OF DEATH
<br /> BUREAU OF VITAL STATISTICS
<br /> STANDARD CERTIFICATE OF DFATH
<br /> FEDERAL SFCURITY AGEI�CY "'
<br /> U. S. PUI�LIC HEALTH SERVICF °
<br /> National Office of Vital Statistics
<br /> Social Security No. 712 05 2672 State File No. 4888
<br /> l. PLACE OF DEATH:
<br /> (a) County Lancaster
<br /> (b) City or town Lincoln .
<br /> (c) Name of hospital or institution; Veterans Administration
<br /> (d) Length of stay: In hospital or institution 50 days
<br /> In this community Same
<br /> 2�. USUAL RFSIDEI`:CE OF DECFAS�D;
<br /> (a) State l�ebraska (b) County Hall
<br /> (c) City or to�,m Grand Island
<br /> (d) Street No. 318 �ast 14th Street
<br /> (e) If foreigh born, how long in i,'. S. A.? years.
<br /> 3(a) FULL NAME BUSL;�R, Edward
<br /> 3(b) If veteran,
<br /> name war Spanish-American War
<br /> , 4. Sex Male
<br /> 5. Color race [��hite
<br /> 6(a) Single, widowed, married, divorced i��arried
<br /> 6(b) :��ame of husband or wife Jennie Busler
<br /> 6(c) Age of husband or wife if alive 64 yrs.
<br /> ?. Iiirth date of deceased March 21, 1880
<br /> 8, AGE: Years 68 Months 1 Days 10 If less than one day
<br /> 9. Birthplace Gainsville, riissouri
<br /> 10. L'sual occupation Retired
<br /> 11. Industry or business
<br /> Father ( 12. I�ame Henry Clay t3usler
<br /> ( 13. �3irthplace Ohio
<br /> rlother (14, r;ame Sureldia Stropes
<br /> ( 15. Birthplace Ohio
<br /> 16.(a) lnforma�h�s own signature Records, �'et. Adm.
<br /> (b) Address Lincoln. l, Nebraska
<br /> 17.(a) Removal (r) Date thereof May 1�48
<br /> (c) �?lace: rurzai or cremation Grand Island, lv'ebr.
<br /> 18.(a) Signature of .funeral director Gedd.es Funeral Home
<br /> (b) Address Grand Island, ATebr.
<br /> 19.(a) (Date received local registrar) A1AY 11 1948 (b) (Registrar�s signature) Fred Langan D.
<br /> MED I€7AL CE�T IF ICAT ION
<br /> 20. Date of death; Month May Day l, I94$ 6 hour 30 minute A.�I.
<br /> 21. I hereby certify that i attended the deceased from March 12, 1948, to May 1, 1948, that I last
<br /> saw him alive on �1ay l, 1948: and that death occurred on the date an.3 hour stated above. Duration
<br /> Immediate cause of death Cardiac failure with decompensation 1 mo.
<br /> Due to f�ypertensive cardi.ovascular disease 1 yr.
<br /> Due to-----
<br /> Other conditions PH'�SICIAI�
<br /> Major findings; Of operations Na surgery
<br /> of autopsy No autopsy
<br /> 22, If death was due to exterr.al causes, fill in the follawing:
<br /> (a) Accident, suicide, or homicide (specify)
<br /> (b) Date of occurence
<br /> (c) tti�here did injury occur?
<br /> (d) Did injury occur in or about home, on farm, in industrial place, in public place? While at work?
<br /> Means of ir.jury
<br /> 23. Signature J. S. Walsh, r�I,D. Chief, Professional Services, Vet., Adm. Lincoln 1, Nebr. 5-1-48
<br /> 25. I hereby certify I personally embalmed the body of the deceased named herein.
<br /> W. G. Geddes
<br /> License No. 1315
<br /> THTS CERTIFIES THE AT�OVE TO BF. A TPUE COPY OP AN Of�IGI1�AL CERTIFICATE Ol� FILE WITH THE STATE DEPARTNIENT OF
<br /> IiEALTH, I3UREAU OF VI�1L STATISTICS, ti�fiIC�� IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br /> W. S. Petty, M. D.
<br /> �I}ZECTOR OF HEALTH AIlD STAT� REGISTRAF LII�COLl�, 11'EBRASKA APR 11 1949.
<br /> Filed for record this .7 day of March 1951, at 2:45 ofclock P.M. �'+ / � D
<br /> Cool.v�.ai U:LV�vw
<br /> Register of Deeds �
<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-ao-o-o-o-o-o-o-o-ao-o-ao-o-
<br /> AFF IDAV TT
<br /> I1� THE MATTER OF THE TITLE TO LOT FOUR (4) IN BLOCK TWENTY FIVE
<br /> (25) II� RUSSI:L WHFELER�S ADDITI01� TO THE CITY OF GRAND ISLAND,
<br /> NEI3RASKA
<br /> STATE Or �T�I3RASKA )
<br /> )SS
<br /> COUNTY OF HALL )
<br /> CARL KNICKREHri, being first duly sworn upon his oath deposes and says that he is a resident of Grand
<br /> Island, Nebraska; that he has been a resident of Grand Island, I�ebraska, for more than forty years last
<br /> past; that he was well and personally acquainted with �Jilliam Elliehausen, also known as Wilhelm Elliehausen,
<br /> that they were one and the same person; that on August 24, 1918, said William Elliehausen was the lawfully
<br /> wedded husband of �mma Elliehauser., to whom subiect property was deeded zqn the date aforesaid.
<br /> Further affiant saith not. Carl Knickrehm
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