Fisher Family Genealogy

Death Certificate: Percy, William Andrew - 1936



Source Information    |    Media    |    Notes    |    All

  • Title Death Certificate: Percy, William Andrew - 1936 
    Short Title Death Certificate: Percy, William Andrew - 1936 
    Author Henry Hern? 
    Publisher Nebraska Department of HHS Finance & Support 
    Call Number G12054 
    Repository Nebraska Department of HHS Finance & Support 
    Source ID S24 
    Text State of Nebraska
    Department of Health-Division of Vital Statistics
    CERTIFICATE OF DEATH
    G12054
    Form 243-6
    1. PLACE OF DEATH
    County Saline
    Township (blank)
    City Wilber, Nebr. No. (blank) Street (blank) {If death occurred in a hospital or institution give its NAME instead of street and number.
    Length of residence in city or town where death occurred 58 yr. (blank) mo. (blank) da. How long in U.S. if of foreign birth (checkmark) yr. (checkmark) mo. (checkmark) da.
    2. FULL NAME William Andrew Percy
    1a. Residence: State Nebr. County Saline City Wilber No. (blank) Street (blank)
    PERSONAL AND STATISTICAL PARTICULARS
    3. SEX Male / 4. COLOR OR RACE White / 5. SINGLE Married Divorced (write the word) Married
    5a. If married, widowed or divorced HUSBAND OF/WIFE OF Martha Jane Percy
    6. DATE OF BIRTH (mo.) March (day) 15 (year) 1860
    7. Age Years 76 / Months 7 / Days 24 / If less than 1 day Hrs. (blank) or Min. (blank)
    OCCUPATION
    8. Trade, profession or particular kind of work down, as spinner, sawyer, bookkeeper, etc. Painter
    9. Industry or business in which work was done as silk mill, saw mill, bank, etc. (checkmark)
    10. Date decesaed last worked at this occupation (month and year) Aug. 1936
    11. Total time (years) spent in this occupation Lifetime
    12. Birthplace {City or Town and State or Country Boston Mass.
    13. Name of Father William Henry Percy
    14. Birthplace of Father {City or Town and State or Country England
    15. Maiden name of Mother Stuart
    16. Birthplace of Mother {City or Town and State or Country Scotland
    17. INFORMANT Martha Jane Percy (Address) (blank)
    18. BURIAL, CREMATION, or REMOVAL
    Place Wilber Date Nov. 10, 1936
    19. UNDERTAKER Fred Shimerda (Address) (blank)
    20. Filed 11/11, 1936 (signed) Wm. ??
    MEDICAL CERTIFICATE OF DEATH
    21. DATE OF DEATH Wm Andrew Percy Nov 9, 1936
    22 I HEREBY CERTIFY, That I attended deceased from Sept 1, 1936, to Nov. 9, 1936
    I last saw him alive on Nov 8, 1936, death is said to have occurred on the date stated above at 3:45 a.m.
    The principal cause of death and related causes of importance in order of onset were as follows:
    Cirrhosis of Liver / Date of Onset IMPORTANT july 1, 36
    Contributory causes of importance not related to principal cause:
    Diabetis
    Name of operation (blank) Date of (blank)
    What test confirmed diagnosis? (blank) was there an autopsy? (blank)
    23. If death was due to external causes (violence) fill in also the following:
    Accident, suicide or homicide? (blank) Date of (blank) 19 (blank)
    Where did injury occur? (Specify city or town, county and state) (blank)
    Manner of injury (blank)
    Nature of injury (blank)
    24. Was disease or injury in any way relating to occupation of deceased? (blank)
    If so, specify (blank)
    (Signed) Henry Hern? M.D.
    Address) Wilber, Neb
     
    Linked to (3) PERCY William Andrew
    PERCY, William Henry
    STUART OR STEWART, Catherine 

  • Documents
    Death Certificate: Percy, William Andrew - 1936
    Death Certificate: Percy, William Andrew - 1936

  •  Notes 
    • From Wikepedia entry on Cirrhosis: Cirrhosis is a chronic disease of the liver in which liver tissue is replaced by connective tissue, resulting in the loss of liver function. Cirrhosis is caused by damage from toxins (including alcohol), metabolic problems, chronic viral hepatitis or other causes. Cirrhosis is sometimes referred to by its obsolete eponym Laennec's cirrhosis after René Laënnec. Cirrhosis is irreversible but treatment of the causative disease will slow or even halt the damage. Cirrhosis may refer to chronic interstitial inflammation of any tissue, but is rarely used for other diseases than cirrhosis of the liver.