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Vital records and other important documents in the life of Mary Cleo Hansen Lyons (1916 - 2003)

A Collection of Vital records and other important documents in the life of Mary Cleo Hansen Lyons (1916 - 2003).



Table of Contents

1 Table of Contents
2 Vital Records Documents
2a Birth Certificate
2b Addendum to Birth Certificate
2c Marriage License and Certificate
2d Death Certificate
3 Church Documents
3a First Temple Recommend (Front Side)
3b First Temple Recommend (Back Side)
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Vital Records Documents


Table of Contents

Birth Certificate


Birth Certificate for Mary Cleo Hansen

Information from the Certificate

STATE OF UTAH
CERTIFICATION OF VITAL RECORD

This certificate must be forwarded by the local registrar to the State Board of Health, Salt Lake City, on or before the 5th of the following month, after first having been promptly registered.

State Board of Health File No: 525

CERTIFICATE OF BIRTH

State of Utah

Stamp on the form     Amended | 1 of 2

PLACE OF BIRTH

County of: Sevier

Precinct of: Richfield

Town or Village of: ______

City of: Richfield

Street and No.: ______

(If in Hospital or other Institution, give its Name instead of Street and Number)

FULL NAME OF CHILD: ______ {If child is not yet named, make supplemental report as directed.}

Sex of Child: Girl | Twin, Triplet or other: \ | Number in Order of Birth: \ | Legitimate: Yes | Date of Birth: June   9, 1916 (Month)   (Day)   (Year)

FATHER

Full Name: Amasa Niels Hansen

Residence: Richfield Utah

Color: White Age at Last Birthday: 38 (Years)

Birthplace (City or Place): Richfield Utah

Occupation: Farmer

MOTHER

Full Maiden Name: Minnie Olsen

Residence: Richfield Utah

Color: White Age at Last Birthday: 38 (Years)

Birthplace: Richfield Utah

Occupation: Housewife

Number of children of this mother: 9     Number of children of this Mother now living 8

CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE*

I hereby cerify that I attended the birth of this child, and that it occurred on June 9 1916 at 6 a. m, on the date above stated.

Premature: no     or Still Birth? no (Yes or No)

{*When there was no attending physician or midwife, then the father, householder, etc. should make this return.}

(Signature) J J Steinor

Date: June 14, 1916       ______ (Physician or Midwife)

Address of Physician or Midwife: Richfield Utah

Filed: July 30, 1916       Peter Christensen Registrar

Registered No: 48


Date Issued: Aug 31 2007       Hologram Seal

This is an exact reproduction of the document registered in the State Office of Vital Statistics. Security features of this official document include: Intaglio Border, V & R images in top cycloids, ultra violet fibers and hologram image of a hawk over the word valid. This document displays the date, seal and signature of the State Registrar of Vital Statistics. Updated Utah State Seal Replaces hawk over valid for authenticity.

'The Great Seal of Utah' is located in both bottom corners.

Preprinted Signature Barry E. Nangle   Preprinted name and title   Barry E. Nangle, State Registar

Barcode *061125429*

Utah Department of Health, Office of Vital statistics and Statistics, Salt Lake City, Utah




Table of Contents

Addendum to Birth Certificate


Addendum to Birth Certificate for Mary Cleo Lyons

Information from the Certificate

SUPPLEMENTAL REPORT OF BIRTH,STATE OF UTAH

This return should preferably be made by the person who made the original, and filed with the local Registrar as soon as child is named

Registered No: 48

Place of birth: Richfield Utah (Registration District)   No.: ______ St.

Sex of Child: Girl | Twin, Triplet or other: __ | Number in Order of Birth: __

Date of Birth: June   9, 1916 (Month)   (Day)   (Year)

FATHER

Full Name: Amasa Niels Hansen

MOTHER

Full Maiden Name: Minnie Olsen

These items to be entered by Registrar before giving out thid form

I HEREBY CERTIFY that the child described herein has been named:

Mary Cleo Hansen

      (Given name in full)       (Surname)

(Signature) J J Steiner

_________________________

(Physician or Midwife)or Midwife is crossed out

Stamp on the form     2 of 2


Date Issued: Aug 31 2007       Hologram Seal

This is an exact reproduction of the document registered in the State Office of Vital Statistics. Security features of this official document include: Intaglio Border, V & R images in top cycloids, ultra violet fibers and hologram image of a hawk over the word valid. This document displays the date, seal and signature of the State Registrar of Vital Statistics. Updated Utah State Seal Replaces hawk over valid for authenticity.

'The Great Seal of Utah' is located in both bottom corners.

Preprinted Signature Barry E. Nangle   Preprinted name and title   Barry E. Nangle, State Registar

Barcode *061125429*

Utah Department of Health, Office of Vital statistics and Statistics, Salt Lake City, Utah





Table of Contents

Marriage License and Certificate


Marriage Certificate for Albert L. Lyons and Cleo Hansen

Information from the Certificate

MARRIAGE LICENSE

THE STATE OF UTAH,           COUNTY OF SALT LAKE

You are hereby Authorized to Join in Holy Matrimony

Mr. Albert L. Lyons of Salt Lake City

in the County of Salt Lake and State of Utah over the age of 27 years, and

Miss Mary Cleo Hansen of Salt Lake City

in the County of Salt Lake and State of Utah over the age of 20 years.

Witness my hand and official seal this 29 day of Jan 1937

By Johna Harter Deputy Clerk


THE STATE OF UTAH

COUNTY OF SALT LAKE} ss.     I hereby certify that on the 29th day of January in the year of our Lord one thousand nine hundred and thirty seven at Salt Lake city, in said County,I, the undersigned, a Bishop of the LDS Church did join in the Holy Bonds of Matrimony according to law Albert L. Lyons of the County of Salt Lake State of Utah and Mary Cleo Hansen of the County of Salt Lake State of Utah The nature of the ceremony was according to law, and was a present mutual agreement of marriage between the parties for all time.

We were married as stated in this Certificate, and are now husband and wife.

Signed, Albert L Lyons Groom.}

Signed, Mary Cleo Hansen Bride.}       Fred W. Schwendiman

In the presence of Mrs. Ruth Lyons Witness.}

Mrs A. N. Hansen Witness.}       Bishop Whittier Ward, LDS Church





Table of Contents

Death Certificate


Death Certificate for Mary Cleo Hansen Lyons

Information from the Certificate

STATE OF UTAH
CERTIFICATION OF VITAL RECORD

State of Utah - Department of Health

Certificate of Death

Accdess to information on this form is limited under the Vital Statics Act and rules   Date stamp Aug 13 2003   Local File number 18-3481         State File Number 2003 007712

Decedent

1. NAME of DECEDENT First Middle LastMary Cleo LYONS   |   2. SEX Female   |   3a. DATE of DEATH (Mo., Day, Year) August 1, 2003   |   3b. TIME of DEATH (24 hr. clock) 0550 hr

4. DATE of BIRTH (Mo., Day, Year) June 9, 1916   |   5. AGE (Last Birthday) 87 Yrs.   |   IF UNDER 1 YEAR Months __ Days __   |   IF UNDER 24 HOURS Hours __ Minutes __   |   6. BIRTHPLACE (City & State or foreign Country) Richfield, Utah   |   7. SOCIAL SECURITY NUMBER Confidential

8a. PLACE OF DEATH (Check only one) Hospital (Status codes for Hospital only): __ 1. In patient   __ 1. ER/Outpatient   __ 3. DOA | ALL OTHER LOCATIONS: X 5. Nursing Home   __ 6. Residence   __ 7. Other(Specify)   |   8b. NAME OF HOSPITAL, NURSING HOME OR OTHER FACILITY (If outside a facility, give street address of location) Eastridge care Center

8c. CITY or TOWN OR LOCATION OF DEATH SALT LAKE CITY   |   8d. COUNTY OF DEATH SALT LAKE   |   14. SURVIVING SPOUSE (If, wife, enter maiden name) __

10. WAS DECEDENT EVER IN THE U.S. ARMED FORCES? __ 1. Yes X 2. No   |   11. Marital status __ 1. Never Married __ 2. Married X 3. Widowed __ 4. Divorced   |   12a. DECEDENT'S USUAL OCCUPATION (Give kind of work done during most of working life, Do NOT enter retired) Homemaker   |   12b. KIND of BUSINESS or INDUSTRY Own Home

13a. RESIDENCE - STREET AND NUMBER 2730 East 3300 South   |   13b. CITY or TOWN OR COMMUNITY Salt Lake City   |   13c. COUNTY Salt Lake   |   13d. STATE utah

13e. INSIDE CITY LIMITS? X 1. Yes __ 2. No     13f. ZIP CODE 84109   |   14. WAS DECEDENT of HISPANIC ORIGIN? __ 1.   Yes X 2. No (If yes, Specify) __ 1. Mexican __ 2. Cuban __ 3. Puerto Rican __ 4. Other (Specity) ____   |  

8. CITIZEN of What Country U.S.A. 11. EDUCATION -- (Specify only highest grade completed) Elementary or Secondary (0-12) College (15-16 or 17+) SECONDARY (12)   |   3. RACE (white, Black, Am. Indian, etc.) Specify WHITE   |  

15. NAME of FATHER GEORGE EMERY LYONS   |   16. MAIDEN NAME of MOTHER RUTH HAZEL SAINSBURY   |  

18c.CITY or TOWN SALT LAKE CITY   |   18d. COUNTY SALT LAKE   |   18e. STATE UTAH   |   19. NAME & MAILING ADDRESS of INFORMANT CLEO LYONS   2004 STRATFORD DR.   SALT LAKE CITY, UTAH 84109

21a. MEDICAL EXAMINER: I hereby certify that to the best of my knowledge the death occurred at the hour, date and place stated above from the causes stated below based on examination of the body and/or investigation of the circumstances. Decedent was pronounced dead at: HOUR __ DATE __   |   21b. PHYSICIAN OR MEDICAL EXAMINER SIGNATURE G H Curtis   |   21C. TIME of Death (24 hr. clock) 0920

22. PHYSICIAN: I hereby certify that to the best of my knowledge the death occurred at the hour, date and place stated above from the causes stated below, that I attended the decedent, and I last saw the decendentalive on: month 9 day 1 year 81   |   21e. CERTIFIER'S name and title (Type and Print) G. H. Curtis MD   |   21f. DATE SIGNED (Mo., Day, Year) 9-2-81

23a. Burial X Removal __ Entombent __ Cremation __ Other __   |   23d. DATE SEP. 4, 1981   |   24. SIGNATURE of Funeral Director M A BEARD Printed MICHAEL A. BEARD   |   25. FUNERAL HOME--Name, address and license number DESERET NORTUARY * S.L.C., UTAH

26. NAME AND LOCATION OF CEMETERY OR CREMATIORY LAKE HILLS MEMORIAL PARK * SANDY, UTAH   |   27. LOCAL REGISTRAR--Signature Harry D Talebous m.D.m.PH (mm)   |   28. Date accepted for registration by local registrar Sept. 2, 1981

29. PART I. DEATH WAS CAUSED BY: (Conditions if any which gave riSe to the immediate cause (A), Stating the underlying cause last.) IMMEDIATE CAUSE: (Enter only one cause per line for A, B and C)   (A) Cardiac Arrest   |   Interval between onset and death 1 minute   |  
DUE TO, OR AS A CONSEQUENCE OF Arteriosclerotic Heart Disease   |   Interval between onset and death 10 Years
DUE TO OR AS A CONSEQUENCE OF (c) ____   |   Interval between onset and death ____

30. PART II. OTHER SIGNIFICANT CONDITIONS -- CONTRIBUTING TO DEATH, BUT NOT RELATED TO THE IMMEDIATE CAUSE GIVEN IN PART 1 Polymyoritis   |   31a. AUTOPSY YES __ NO x   |   IF YES, were findings considered in determining cause of death? YES __ NO __

32. Accident __   Suicide __   Homicide __   Pending investigation __   Undetermined if injured Accidently or Purposely __   |   33a. DATE of Injury (Mo., Day, Year) ___   |   33b. TIME OF INJURY (24 Hour Clock) ___   |   34. INJURY AT WORK? YES __ NO __   |   35. PLACE OF INJURY (Specify home, fram, factory, freeway, street, office buildings, etc.) ___

36a. LOCATION OF INJURY -- STREET AND NUMBER OR LOCATION AND CITY OR TOWN. ____   |   36B. Distance from place of Injury to usual residence (Item 18) ____ Miles   |   37. Were laboratory tests done for drugs or toxic chemicals? YES __ NO __   |   38. Were laboratory tests done for alcohol? YES __ NO __

39. DESCRIBE HOW INJURY OCCURRED (enter sequence of events whichresulted in injury, NATURE OF INJURY SHOULD BE ENTERED IN ITEM 29) ____   |   40. If motor vehicle accident, specity if decedent was driver, passenger or pedestrian.


Date Issued: Sep 20 2007       Hologram Seal

This is an exact reproduction of the document registered in the State Office of Vital Statistics. Security features of this official document include: Intaglio Border, V & R images in top cycloids, ultra violet fibers and hologram image of a hawk over the word valid. This document displays the date, seal and signature of the State Registrar of Vital Statistics. Updated Utah State Seal Replaces hawk over valid for authenticity.

'The Great Seal of Utah' is located in both bottom corners.

Preprinted Signature Barry E. Nangle   Preprinted name and title   Barry E. Nangle, State Registar

Barcode *061131963*

Utah Department of Health, Office of Vital statistics and Statistics, Salt Lake City, Utah




Church Documents


Table of Contents

First Temple Recommend (Front Side)


First temple recommend for Mary Cleo Hansen (front side)

Information from the Recommend

TEMPLE RECOMMEND

CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS

Stamp with recommend expiration date Jun 30 1942         This copy to be presented at the Temple by applicant

1. Name in full   Do not use abbreviations or initials
Issued to Mary Cleo Hansen (Lyons) a member of record, to receive ordinances specified herein. State Priesthood held _____________
Check marriage status thus check mark.   Single____   Married check mark   Widower____   Widow____

2. Check thus check mark Ordinances to be received
Own Endowment check mark       Marriage: (Licensed_____)       (previously married_______)
Civil Marriage--Date 29 Jan 1937 Place Salt Lake City Utah
Sealing to Parent Parent crossed out husband and 3 children to parents.       Baptism for Dead only_____       All ordinances for the Dead______

3. Fillin completely if recommended for own endowment, marriage or sealing to parents
Birth Date 9 June 1916       Birth Place Richfield Utah (Town   County   State or country)
Baptismal Date 7 Sept 1924       If previously endowed, Give Date 5 Jun 1942 B
Father's Name Amasa Hansen   Mother's Maiden Name Minnie Olsen
Name of Husband or Wife, Groom or Bride to be Albert Lewis Lyons

4. Date Issued May 31, 1942 for Salt Lake Temple
From WhittierWard or Branch Wells Stake or Mission
F W Schwendiman (Signature of Bishop or Branch President)       Thos E. Dawley Signature of Stake or Mission President

Reserve this space for temple use Stamps on recommend Prev-Mar'd   To be Sealed   Own Endoment This recommend expires: bottom right hand corner was torn out and is missing






Table of Contents

First Temple Recommend (Back Side)


First temple recommend for Mary Cleo Hansen (back side)

Information from the Recommend

STATEMENT TO BE FILLED IN BY THE APPLICANT

1. Are you morally clean and fit to enter the temple? Yes (Yes)   _____ (No)

2. Will and do you sustain the General Authorities of the Church and will you live in accordance with the accepted rules and doctrines of the Church? Yes (Yes)   _____ (No)

2a. Do you have any connection, in sympathy or otherwise, with any of the apostate groups or individuals who are running counter to the accepted rules and doctrines of the Church? _____ (Yes)   No(No)

3. Are you a full tithe payer? _____ (Yes)   _____ (No) No answer given for this question

3a. Are you a part tithe payer? _____ (Yes)   _____ (No) No answer given for this question

3b. Are you exempt from paying tithes? Yes   _____ (No)

4. Do you keep the Word of Wisdom? Yes   _____ (No)

5. Do you wear the regulation garments? _____ (Yes)   No (No)

6. Will you earnestly strive to do your duty in the Church, to attend your sacrament, priesthood, and other meetings and to obey the rules, laws, and commandments of the Gorpel? Yes (Yes)   _____ (No)

7. Have you ever been denied a recommend to any temple? _____ (Yes)   No (No)

        If so, please indicate: ____________ (Name of Bishop, Ward, Stake, and Date.)

(Signed) Mary Cleo Hanson Lyons

bottom left hand corner was torn out and is missing