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� 2�� I�IISCELLaANEOUS R�CORD W 38289�TNEAUGUSTINECO.GRANDISL�NO.NEBR. ' . . AFFTDAVIT /�f` IN THE MATTER OF T TTLE TO LOT E IGHT (8), IN BLOCK SEVENTEEN (17) IN COLL�GE ADDTT ION TO WEST LAWN, IN THE Cl'fY OF GRAND ISLAND, HALL COUIvTY, NEBRASKA. �TATE OF NEBRASKA ) _ ) SS: AFF IDAV IT COUNTY OF HALL ) ALBERT' E. JOHNSON, being first duly sworn, deposes and says that he was formerly the owner of the above described lot; that the same was held as joint tenant �ith his wife, Ruth Johnson; that on September 29, 1951, affiant and wife conveyed said property to Wallace A. Johnson and Kathryn Ann Johnson, said Wallace A. Johnson being a son to affiant herein; that said propertp was not conveyed to Wallace A. Johnson and his wife as a gif�, but was made f or the purpose of rnaking arrangements so that the said Wallace A. Johnson and �ife could secure the payment of certain indebtednesses oweing by them to the affiant herein and his wife, Further affiant sayeth not. . Albert E. .Tohnson AFFIANT Subscribed in my presence and sworn .to before me this 28th day of January, 1952. My commission expires Aug.: 17, 1957. (SEAL) B. .T. Cunningham. .Tr. NOTARY PUBLIC �'iled for record this 8 day of March 1952, at 9:00 otclock A. M. � � � � ��'�r� Register of Deeds o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-o-ao-o-ao-ao-o-ao-o-o-o-o-o-o-o-o-o-ao-o-o-o-o-o-ao-o-o-o-o-o-o-o CERTIFICATE OF DEATH � �/ �tC 0 P Y�� State File No. FEDERAL SECURITY AGENCY STATE OF COLORADO U. S. .Public Health Service STANDARD CERTIFICATE OF DEATH Registrarfs No. Dist� Form V. S. No. 16 l. PLACE OF DEATH - 2. USUAL RES IDENCE A. GOUNTY Mesa A: STATE Colorado B. CITY OR TOWN Grand Junction B. COUNTY Mesa C. LENGTH OF STAY (in this place) 2? years C. CTTY OR TOWN Grand Ju�iction D. FULL NAME OF HOSPTTAL OR iIISTTTlTTI0N2805 Elm Ave. D. STREET ADDRESS 2805 Elm Ave. 3. NAME OF DECEASED Bert William Welch 4. DATE OF DEATH September 14, 1951 5. SE% Male 6. COLOR OR RACE White 7. MARRIED, NEVER MARRIED, WIDOWED, DIVORCED Ma.rried $. DATE OF BIRTH June 7, 1880 9. AGE ?1 10a. USUAL OCCIIPATION Farm Manager lOb. KIND OF BUSINESS OR INDUSTRY Agriculture 11. BIRTHPLACE Buffalo Courity, Nebraska 12. CITIZEN OF WHAT COUNTRY? U. S. A. 13. FATHER�S NAME Ruben Welch 14. MOTHER�S MA IDEN NAME Judith Coverley 15. WAS DECEASED EVER IN U. S. ARMED FQRCES? No 16. SOCIAL SECUR TTY N0. None 17. INFORMANT Nettie B. Welch MED ICAL CERT IF ICAT ION INTERVAL BETWEEN 18. CAUSE OF DEATH i. DISEASE OR CONDTT ION DIRECTLY LEADING TO DEATH ONSET AND DEATH (A) Occlusion, coronary theombosis 10 hrs. DUE TO (B) Occlusion coronary old posterior DUE TO (C) Mpocardial infarct 3 yrs. I I. OTHER S IGNSF ICANT COND TT IONS Ulcer gastric, posterior Wall 5 raonths 19 A. DATE OF OPERATION _ 19 B. MAJOR FINDINCS OF OPERATION -,- 20. AUTOPSY? No 27, A. ACCIDENT SUICIDE HOMICIDE --- 21 B. PLACE OF INJURY --- 21 C. CITY� TOWN� OR TOWNSHIP� COUNTY STATE 21 D. TIME OF INJURI� ----- M 21 E. INJURY OCCIIRRED WHILE AT WORK--NOT WHILE AT WORK --- 21 F. HOW bID INJURY OCCUR? ------ 22. I hereby certifp that I attended the deceased from 7/13 I951 to 9/14,1951 that I last saw the deceased alive on 9/14, 1951, and that death occurred at 6;15 A. M. from the causes and on the date stated abo've. 23 A. S IGNATURE Paul B. Marasco M. D. 23 B. ADDRESS Grand Junction, Colorado 23 C� DATE S IGNED 9�14 - 51 24 A. BURIAL, CREMATION, REMOVAL Burial 24 B. DATE Sept. 17, 51 2 4 C. NAME OF CF.�fETERY OR CREMATORY Orchard Mesa Cemetery 24 D. LOCATION Grand Junction, Colorado DATE REC�D BY LOCAL REG. 9/17-51 REGISTRAI��S SIGNATURE Helen Tomlinson 25. . FUNERAL DIRECTOR Martin�s Mortuary - Grand Junction, Colo. Filed for record this 10 day of March 1952, at 8:45 otclock A. M. .�.�.r� � e�,�.�,,.. Register of Deeds � _ . �__._ : �_ k