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1. PLACE(1 nEATII • _-_._-- 1.tw ut STATISTICS_p`' 'Do not rrft. h -�� <br /> Form:u 1 <br /> Could). CERTIFICATE OF DEATH <br /> T r <br /> _ ci rrt 64.�.�a 7--?-k—• <br /> "' - II d th uned RI <br /> .. v I lit rte { <br /> C gl Id b E <br /> s�-y 2 r ). I in/ d I street d ammber <br /> Length of rttel t et,. �.r tten whir death oceu T <br /> r.__ �____.de. II long in U.S. f of foreign birth__1r.._._.yto_—A.. <br /> PERSONAL AND STATISTICAL PARTICULARS MEDIC CERTIFICATE OP DEATH <br /> , 5 (\1 the word) 16 DATE UF'DEATH J `,F.\ e ( l∎lit or RACC S 1 ... _ -- <br /> M -ed fLovthl y) <br /> 1 Wooed <br /> I D ced 1 I/nII h_REM( T.That I attended deceased from_ <br /> - I. I d,.r d- 1 /At, /e/)- 19 t(/t .. __._19At <br /> 11\IFF\f l � / _— --__/ A/ R I I 1 1.1 ,14-ta n-.1- �-�w 19%i' <br /> ( I A11 e e l I IR1It Ono.6 ,,,„)_// (yr)!� d e a t h .n the date tatM,nt`/'�`��j���' <br /> i Age 1"rare Months hays li Ircr thmn, t'AUSE OF'II EAT 1h•th•from vloleon•tut mean•RM nature <br /> �� f niur, 1 rther dr t I tcidsl, h cidai.) <br /> -,1 11 OCC(11130\D t Ci:ASLU � I ...._.. <br /> T J 1 of llr <br /> p articular lednd of nettle -... _._. _.. <br /> hue( 1 f d s, - ..... (dust ) y __ da. <br /> 1 r t bl h [ CO\T IRUTOR} �� ✓ /tamer. <br /> gyp/J s _.da. <br /> al-oo mo <br /> 4 9 B..0,1.— l( I �"K.i.' _..._ 7R a 1�`.phc f dear, 1. <br /> 3: I r to ntrt ' 1,d n omen.n precede d the-11419ate a _Cause <br /> In\erne.n 1,tl <br /> i <br /> Ihrt Dla.e f - ../e <br /> II <br /> 1l Malden mote d \I el .�..`�... /f _ ... \\a.three el metope, ... AV.. ....... <br /> Soft]ace i( <br /> " <br /> 1other or to r� ' 1 <br /> _..�� -... ( t / a •) <br /> k amQ —4, r IY r u burial, a m•at D a d . <br /> ,a Informant <br /> Address" 1 I'nAenaler dress <br /> iI V l odrar _tea I _'a `art,a;_ a • i; 0 <br /> • <br /> l • / <br /> / ,-,-1 : , I 1 t y / <br /> • <br /> / • <br /> THIS CV IF S THE •: V. TO BE A TRUE COPY OF AN ORIGINAL <br /> CER_TIP 4II'tE AN RILE ITtT J"IE STATE DEPARTMENT OF HEALTH, <br /> •BUREAU' ,uV. •\L - 4?IS�'IXS. WHICH IS THE LEGAL DEPOSITORY.._ <br /> FOR V T ORD3•a �' ,‘,..„---,...) <br /> DIRECTOR OF ITAL S ATI TICS AND ASSISTANT STATE REGISTRAR <br /> LINCOLN, NEBRASKA Issued November 6, 1953 <br /> /—.2- 3- 9 S ,‘l. Y_ 024.../o eeFee1d2�.�.,-.,, <br /> \I " <br /> CERTIFICATE OF DEATH <br /> DEPT. OF HEALTH, STATE OF NEBRASKA <br /> LEONARD JEWETT ))HANCHETT <br /> \.. T T;^ r' °- ,s9. <br /> .1. 1 <br /> 'v /,,rti`y tr;'` the thsstrument wag <br /> : ..._erica, ,x a _..,,d for <br /> _... 7 <br /> November ,,,53 at 9:20 <br /> 0'c,: _. A• .red r.:cT:':ed L'I book <br /> NO. 1 of Mi s c at <br /> ' <br /> RegiSi:T IS LC=_ds <br /> . <br /> Deputy <br /> Fri 2.25 <br /> _ e„ / -. <br />