CERTIFICATE OF DEATH

 1. PLACE OF DEATH:                                                  2. USUAL RESIDENCE OF DECEASED:

    (a) County    Chippewa                                              (a) State    Wisconsin  (b) County    Chippewa                      

    (b) Township    Delmar                                              (c) If rural           R 1                                          
           or                                                                           Give township (not postoffice)
        City or Village  R 1 Cadott Wis.                                        or
                                                                            City or Village    Cadott Wis.                                  
    (c) Name of hospital
        or Institution    none                                          (d) Street No.                                                      

 3. (a) Full Name                                                   MEDICAL CERTIFICATION

     Alexander Lancor                                               19. Date of death: Month   January     Day     10      Year     1948    
 3. (b) If veteran,               3. (c) Social Security
                                                                    20. I hereby certify that I attended the deceased from  October , 19  47 
        name war   None           No.     None                     
             5. Color or           6. (a) Single, widowed, married,     to  January , 19 48 ; I last saw   him   alive on   Jan 10  , 19 48 

 4. Sex Male    race White                divorced   Widowed            and that death occurred on the date stated above at    5:40 P.M.    

 6. (b) Name of husband or wife    6. (c) Age of husband or wife if 21. Immediate cause of death                                 Duration

       Elizabeth Van Horn                 alive   Deceased   years.                 Terminal pneumonia                           3 hours    

 7. Birth date of deceased       March          2          1861         Due to      and pulmonary edema                                     
                                (Month)       (Day)       (Year)
                                                                                    Lymphosarcoma                                6 yrs.     
 8. AGE: Years       Months       Days         If less than one day
                                                                                    parotid gland primary site                              
           85          10           8                 hr.      min.
                                                                        Other conditions                                                    

                                                                                                                                            
 9. Birthplace  Ontonagon                 Michigan                                  Include pregnancy within 3 months of death
               (City, town, or county)   (State or foreign country)
                                                                        Name of                        Date
10. Occupation and industry or business     Retired farmer                operation                                                          

11. Father's name   Mitchell Lancor                                     Major findings:
                                                                          Of operation                        
12. Birthplace                            Canada                   
               (City, town, or county)   (State or foreign country)     Autopsy    No     
                                                                        Performed? Yes    
13. Mother's name   Mathilda (unknown)                             
                                                                        Findings:
14. Birthplace                            Canada                   
               (City, town, or county)   (State or foreign country) ------------------------------------------------------------------------

15. (a) Informant  Mrs. Fred Naiberg                                22. If death was due to external causes, fill in the following:

    (b) Address  R 1 Boyd Wis                                           (a) Accident, suicide or homicide               (b) Date            

16. (a)  Burial                      (b) Date thereof  1   12  48       (c) Where did injury occur?                                         
        (Burial, cremation or other)                  (Mo)(Da)(Yr)                             (city, village or township, county and state)

    (c) Place: burial or cremation  St. Joseph's (Boyd)                 (d) Did injury occur in or about home, on farm, in industrial place,

17. (a) Signature of funeral director  Eugene L. Supple                     in public place?                         While at work?         
                                                                                             (Specify type of place) 
    (b) Address  Boyd Wisconsin                                    
                                                                        (c) Means of injury                                                 
18. (a)  Jan 23, 1948                  (b)  Mary T. Emerson                                 (Fall? Auto? Machinery? etc.)
        Local Filing Date                  Signature of
                                           County Register of Deeds 23. Signature  Robert K Salter                           (M.D. or other)

    (c) State Registrar's Filing Date:                                  Address  Cadott, Wis.         Date signed  January 22, 1948         

NOTE: Transcribed from copy of original document on file at State of Wisconsin Vital Records, P.O. Box 309, Madison WI 53701-0309.