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It <br />.As`/ Z.. <br />I DEPARTMENT OF PUBLIC HEALTH, I.N. VC NEBRASKA Ij <br />- EDUCATION AND WELFARE DEPART31ENT OF HEALTH <br />Bureau of Vital SLIOStiL's <br />BIRTH No. 126_._... CERTIFICATE OF DEATH STATE FILE NO <br />j9 <br />z <br />I G <br />I II PLACE <br />COUNTY OF CASH <br />couxrr D Adams -"_ <br />b. CITY. TOWN, OR LOCATION <br />—1N16 <br />2. USUAL PESIDENCE(R'e,.1 —d-d ! <br />5T(._E e. COLITr <br />I.ebr. . ldams <br />[. LENGTH OF STAY <br />Hastings 12 yrs. <br />[. CITY, TOWN, OR LOCATION <br />Hastings <br />d. NAME OF x.11 not in A "eyital, give e(crrt added,) <br />SPITAL OR <br />d. STREET ADDHE55 _ <br />N nnTION i'ary Lanning ;emorial Hos ital <br />743 No. Munn. <br />r. IS PLACE OF DEATH INSIDE CITY LIMIT51 Y,SX NO <br />r. IS RESIDENCE INSIDE CITY LIMITS' YES' f. FARM RESIDENCE! TESO <br />Foo ROD <br />.J DECEASED tenet Middf[ Lwr 4. DATE Month DaV Yrar <br />(T,M a, P,inn William Henry- Thaden °` Nov. 28 1959 <br />D ATH <br />Male 6 <br />OR OR RACE T ....... NEVER MARRIED❑ 8 DATE OpF BIFTpH[ 9. AGE (/n Vrare IF DIX I YEAF F UNM"_il HAS <br />4 White 19ar.8 1886 an lii[fAdaYl V_U Dow <br />WIDOWED❑ DIVORCED 'r3 <br />IOa. SVAE bCCUPATH)N (Gill Oil. ofu,ork danr IOD NINDOF BUSIXESSOR INDUSTRY I7. BIgiNPLACf (JlN[ar foiryn touwrYJ 12. CI iEX OF WHAT COUNTRYT <br />ax. in, Ewa rllnP n /r, n yened' Farming Illinois U.S.A. <br />13a. FATHER'S NAME 13b. MOTHER'S MAIDEN NAME 14. NAME OF HUSBAND OR WIFE <br />Harm Thaden Olive Tt,: Irmal Thaden <br />IS. WAS DECEASED EVER IN U S. ARMED FORCE51 I6. SOCIAL SECURITY NO. I1 IMFONM.NS Addrr. <br />LYV 1xs.Will H.Thaden 743 No Minn. <br />IB. £AYH 0/ DEATH [Enrol "IF on[ <auu 1Hr li nr (a), () . an. (c).) INTEflVAL BETWEEN <br />PART 1. DEATH WAS CAUSED BY: � /L /{QE / r- ONSET AND,{IEATM " <br />IMMEDIATE CAUSE <br />Co ditione, it any. DUE TO (b) <br />RAW P iel <br />aLOUr [cu ral. ... — <br />rarmY rntda ar.. I( <br />r iwl, J DuE To (U <br />O PART 11. OTHER SIGNIFICANT CONDITIONS IMO TO DCATH BST NOT REIATEO TO THE TEANINAL DISEASE CONmT101 GWEN Ix PART I(n) WAS A OPSY <br />PERFORMED' <br />U ,-A ' j <br />YES❑ NO l4— <br />F <br />EZM%ACC IDENT ESUICIM HOMICIDE 206. DESCRIBE HOW INJURY OCCURRED (Err ri iPI f❑ ❑ EROF h, Do,, Yar U Y P. <br />ifld. INJURY OCCUR RED 20.. PLACE OF INJURY (r. E. in or V, A— 20f CITY. TOWN. OR LOCATION COUNTY STATE <br />WHNC AT ❑ NOT WHILE ❑ /arm, falf.". Nrra, o/nK A'da.� dc.) <br />WORK AT WORK 1. `- <br />21.1.rr.ndedthada°a. 'drrI� L— ;— ,��.�— It -Q —,ro M /nr and I—Aaw live on �7- <br />D.athaeeurred.l—ljr— m nl h. data .1— dab. —and to IN. bnrl Gl m, lnoul.[l,a. I— lh. —U%aaat <br />22. SIGMAS.". (D. pre."fou 226 ADDRESS <br />' 22f. DATE SIGNED <br />23, BURIAL CRE—M. 236 C 23[ FAME f E —Al On CREMA 23d. ATI I. (I It,. loll o count,) (SrWe) <br />"EMOV 5tiRDl /Ate Aec,J. >9 Rosedale ;emetery I"tbtabat of Hastings, Nebr. <br />N. DATE RECD... RFD—l". d.. - STRAR 5 EIGNAT It " 3E. NAME OF MORTUARY ADDRESS <br />DEC 2 1859 r�ra1 ► Lld /li Brand Mortuary Hastings Nebr. <br />Issued January 22, I <br />;� v <br />