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DEPARTMENT REV. PUBLIC STATE OF NrjMASKA <br />DEPARTMENT OF PUBLIC HEALTH. <br />EDUCATION AND WELFARE UEBut�eotl of Vltm OF sta�lon <br />BIRTH NO. 126..._... CERTIFICATE OF DEATH <br />STATE FILE No <br />. <br />1. -PLACE UP DEATH 2Z)$UAL —If - --__._ <br />COUNTY ES76ENC�(Wb.ro t <br />H�11 AT Nebraska b. Gou"TYHallbalwa <br />b. CITY Ilt wtdgd. corpon4 IImIU. writelte Rar rail rd) LEN O T H OF e. CITOYR IIt ontriM oeepon4 Unit., Vrlb EVybL) 1 <br />TOWN_ AZ_cl :STAY <br />TOWN Doniyr___..__ iiin <br />d FULL NAME OF (It of In hmpibl or metitutlon, .1_ Hreet d. 9TREFT (If ryal Alva bntloo) -- <br />HOSPITAL OR a&— ADDRESS <br />.'4e INSTITUTION 1! 7 Qnu.th ,� ' 1d jL __ <br />!i 8 NAME OF (N-) b. (Mldde - (L. — j— <br />I LCEASEI DATE (Monty) (Dy) (T—) <br />;1 .(TYP•_or t).- Walter FNI Bowden _ _ nsnTHr 0et •19.1964 <br />-T __. —__ _. ___ _ _ -- <br />5 SEX d COLOR or RACE?. MARRIED, NEVER MAIL KD.7S DATE OF BI$Tl�9. AG8 (I ir!.t lf. Under 1 Yr. It- Vnd. ,,R_ <br />WIDQJVED, DIVORCED ISowife) _ <br />I,la. L•3VAL OCCUPATION (Give kind of ­k 10b. %1N1) OF BVSINE88 11. BIRTH- (City, town w eoa ty) 84G If- CI'PIEEN OF <br />done,d In. nwt of working II(e. even If retired) OR INDUSTRY PLACE C U-WN WHAT <br />\ C �'O �''iiffilill forolsn at0 �l <br />adzrnes.r_ l I.C. °Olina USA <br />Advance <br />Y ly FATHER'S <br />NAME �lea-.+MOTHER'S MAIDEN NAME 1eb. NAME OF HUSBAND OR WIFE <br />�� Colwtbus__Basadlen_.tie�t�eek _ Fay Bowden <br />.'16 WAS DECEASED EVER IN V B. ARMED FORCES! Id. SOCIAL SECURITY 1?. INFORMANTS NAME or Slanatoroi Addw, <br />Y u k .11! yn el S. Oe date f rvlw) <br />Ito _ _Fay Bowden, Doninhan Nebr <br />- -- - <br />s 2 If Ia. AUBE OF DEATH )HEDIO'U C6RTMbAWON <br />only on ce L DISEASE L CONDITION =1I <br />¢ II t (a), Ibl d 1 11 <br />DIRECTLY LEADING TO DEATH- <br />Pulmonary edma bilateral <br />- (.) ...... ............................... __......__ <br />.. ........ <br />•Thb dew n t lie ANTECEDENT CAUSES awa..r a,l.ta. DDE TO m) . acute dilation of the heart <br />bewt t _ Merbid eandltlsnm I! ........_.._._ ..........._........_.._....... <br />I kh wawd th. rc�.a iSI drW.I.0 teadfetNn�a N.8 .:... ». <br />th. OTHER 91GNIFICANT CONDn70N9 ()arteriosclerotic he.. rt diaea it <br />_ <br />_.... <br />mC .e « <br />�tyy if _denu✓ _.. <br />F7d 19a. DATE OF O �O _- 19b. MAJOR FINDINGS OF OPERATION 80. AUTOPSY? <br />Yw C= No <br />21.. ACCIDENT I ideh 216. PLACE OP INJURY .(It In about Elo. (CITY OR TOWN)) (/ (STATE) <br />HONCIDCIEDE &CCJdeht home.. farm. fwrto ottiw bMr., Rte.) (If rani roe, wflq RURAL�UNTY) <br />21d. TIME (Month) (Day) IYear) (Hour) Yle. -21t. NOW DID INJURY OCCUR? <br />OF a WhIN at Work iJt <br />°p INJURY Oct. 19 1954 10:40 Not Wdlle at workp gas from grain fumigation of <br />C 22. r hefebF cenily that ! attended the deceased `:. <br />.. from ..................... 18........, to 18......o that d tort �t <br />ceased alive on.. .............. 18......... and that death occuFred et..............m., from the causes and on the dots <br />~2- ATU - ID,arw or UUO) 276. ADDRESS ttm 'DATE <br />Coroner Courthouse Orand Island Ne <br />Pea. BURIAL X 84b. DATE gem NAME OF CEMETERY OR CREMATORY add. LOCATION (gy,.�,ppw*Ifli =j <br />CREMATION 1 <br />RBMOVj�A�L��1��@pyelly) EQnti• 23e 00*16t.Viea CemeVttNer,�r Doni has ":H�br <br />' DA 'PayY IJ<aR• R 1 ` SICNAT...I pY09u <br />F L R'S.. RI /!1' <br />Issued December 7, 1954 - <br />+ F <br />r <br />