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PHA:1..i k'SI REV 'A STATE OF NEBR.ASK:I,
<br /> DEPARTMENT 01.'PI DI It HEALTH, DEPARTMENT OF HEALTH
<br /> EDI.t'.STIDN ASP N1.I.F'ARE Bureau of%'Ital StaO.fles
<br /> DIRT))NO. 126 ('ERTIFI(•ATE OF DEATH
<br /> ......._......................
<br /> ISI'AI.RESILIENCE r N'hnre de . )Hied. If Inatitutlort residence
<br /> - • )•LACE:11)'_all .,STATE Nebr• - b.I'OU ee before Wmlalon).
<br /> •.fOlNTY hall
<br /> `h0 b.CI N Af O%,i J<...rl..r.:. A, .,0r In Rural)c.I.E N 1:T I1 Oh' r.PITY If,,ul,:d<c,rrlWrnte limit.,write RURAL)
<br /> Grand Is1an3 T'2 yrs TIIWN Weeping i'•ater
<br /> 0 TOWN
<br /> J.11(.1. NIE I D1 �If n.•! In Ao.1��Ia1 or rn.!rru!i..n. ''''...1 .:'''.1• J._'1'IIIRE' (If rural,olio location,
<br /> IIOSI'ITA1.OR .l \ODRh:SS
<br /> z !NSTITI'I111N 2823 West Koenig Ste _ ---_—_--
<br /> } NAME:11 h' s.rF r•!i b.iMl. I•I c. ILa,:1 1.D.1TE Month) (Day) Near)
<br /> ] IrF.r'hLtSFC VinPrva H. Gorder DEATH Aug. 7. 1954
<br /> __ ITSE or Print) -
<br /> SE 6. Litt or It At I. MA1t1tI FII. NF:\' H ,:r1\II:II. •,1 ATE OF MIRTH . AIiF:Ir yrs.If Under 1 Yr.If Under 2e Hr•.
<br /> ItrLI �.l.rfrl 1 Irt AJ•y) M Iwr,ya Hour• Min
<br /> 4 .
<br /> Female Y�'hite `7'i'n8Wd8` 8/3/1871 �� o �
<br /> lo..I'A!'.\L Ol'r l'l':kTIDN .11.'kin.I..f,.ork lob.EIN11 111 III'SINESS Il.1f1RTlf ICitr.town or county)(St.te 12,CITIZEN OF WHAT 1
<br /> f..f rinrkin �c.e.c O retina,)!
<br /> OR INDUSTRY 1` A" or p rl¢n roan)") C UN RYr
<br /> don during � Wa>�"e oo, is c. II.�.
<br /> n'�ousewl�`e
<br /> I5.FATIIE1t'S NAME Ira MIITIIERS MAII.EN NAME 11b.N,%ME OF HUSBAND OR WIFE
<br /> ''s Eugene E. Tool Hannah Trumbau Fred H. border
<br /> WAS I t:.hSFn ENF:R IS'L'.$..A ItUEn FORC IS• l6.SO1'It L SECURITY 1.I FO RMANT'S NAME or AlFn.ture Addrtu
<br /> lY<..no.toil;°nknown Of y<,¢r °r J.1<.01.111(0) NO. ne.Len laorder, Grand �a1and
<br /> Nebr
<br /> E 1w CAUSE OF DEATH MEDICAL CERTIFICATION 1Inten.l Between
<br /> °_ F.nter only one ra°•e ttir 1 DICFASF;lift rDSDITION t-ryI�1. A•tC � ✓
<br /> Gabel_..M
<br /> ;; line for la),Ito),°' Ic) •IIIIi LISE I I CO INIi Tl)DF:ATII• "t';z C�/ yV. 6�
<br /> lal l 17 llY"t r-
<br /> •Tel.does net mean the ANTECEDENT r\LSFS DUE TO 161
<br /> Ctr OO a
<br /> roniwone:.o:e 0 :•1 ni ucro-4..4.. L':sesw� 7 �
<br /> �� c I T tt
<br /> hwi IIhl PT' In! dl.- Mso<rI0 the bo.e `✓ J
<br /> n,e.. the el.-
<br /> < .r eam.11ca- r underbin¢cause last misty. th. nue TO (a. .,. _ .:.. � __. ........ ........
<br /> tlon which e.a.ea a<•tn., - -
<br /> • 11.OTHER contrihuCANT rthe death �,��
<br /> 14 - - Oont d to a disco.. to M n ca bat .
<br /> 3 VVV•)444
<br /> rotated to th<nalse.w or condition causing not )4,272.4... )---.7.-,17,���' - 1/. � I
<br /> 1 I9.. ATE OF OP RA 191.MAJOR FINDINI:S OF OPERATION 20,AUTOPSY.
<br /> /
<br /> TION Ye. N.a.
<br /> - - :le. CITY OR TOWN) (COUNTY) (STATE)
<br /> 21•.ACCIDENT ISPecifyl 'SIR PLACE OE INJURY le.¢..In°r.bout
<br /> a I write RURAL)
<br /> SUICIDE `i h f f.ctorr.rttrrt afticc told¢..etc 1 III rural area
<br /> HOMICIDE, ---
<br /> •' 215.TIME /Month) (Day) (Year) IHourl Lle INJURY OCCU RR❑ED '1f.HOW DID INJURY OCCUR.
<br /> INJURY m Not While Work—� __.. _---
<br /> S .. _ t -I —
<br /> l
<br /> 8 zz.I Aereby certify t I attended the deceased Jrom.At�M+�i,J9 a,to 7 ade,9..,that I last saw the de-
<br /> ceased aline on _. 1_ ''i9� .,a that death occu,•i6d at.,5 m.,from the causes ayi o'the date stated above.
<br /> 'y1 "A•.SIGNATU IIIegree tl.) 22 D"DRE,39 s (r/ TE- DATE SIGNED
<br /> • 1.BU / 116,DATE 7 21c NAME OF CEMET RY OR CREMATORY Zed.LOCATION (City.town,oe tl) (Sta4)
<br /> CEEMATI ❑ 1,1,0 DATE Oakwood Cmetery Wee•in: Ovate Nebr.
<br /> E. EEMOYAL JA SE,
<br /> P"r �DATE RECD BY j.Q.CA1_L RF%)'- 'S.BICNAT.1 E6.FUNERAL DIRECTORS SIGNATURE ADDRESS
<br /> Wirt I, . I , /,../ !,.. :obaon Funer B•.
<br /> ?t e. 7
<br /> e/
<br /> I'Ills Cf I t l 'TT;sl'ni; Alpc;w'1: "10 1i1' A 'l'Hl'E COIN' 01' AN OISIGINAI.•
<br /> ( 1 R1F7•(4111:ON FILE A
<br /> F Air-4i TIII'. S1"fl: 1)1 l'AFFT1\11:NT OF III-ALT1l.
<br /> fi11RI:A11.°04 'WI l'AI. S"ji`A"PI!,"I'l S. \MilcII 1S 1111: 1.1{GA1, 1)1•:l'OSIIOW,'
<br /> 1 OF V I /
<br /> rt iL I'..••••.,1' . fig f_ �_'/i<ll.✓
<br /> Issued August 19, 1954
<br /> CERTIFICATE OF DEATH 2319
<br /> Department of Health
<br /> State of Nebraska
<br /> Minerva H. Gorder
<br /> State( of Nebraska }
<br /> se
<br /> County of Hall
<br /> Li:tered cn Numerical Index and filed
<br /> for record in Office of Register of
<br /> i-ecds on the ___211____ day of
<br /> , ugu ea 19.1'1__ at a�lir__�
<br /> o'cioci; and 10 n-inutes P• _M.
<br /> and recorded in Book __I______ of
<br /> M,iaael. at page___- __ ■
<br /> 6...e.,......2_��e,.,,.tiaa!
<br /> Register of Deeds
<br /> i-
<br /> By ------------------
<br /> Deputy
<br /> o Fees g?_s?5_----
<br /> m
<br /> r _
<br /> Lel
<br /> _ t. . sd
<br />
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