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<br /> 3aundmrs CERTIFICATE OF DEATH 1 ;1.!■;;
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<br /> ■ ,s ,, ,,, ,, July , 29
<br /> Pst of onset
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<br /> ' ill CERTItriES,TI-itAl3OVE TO BE A TRUE COPY OF AN ORIGINAL
<br /> ',at* FICATt ON RSI:E;W
<br /> ITH THE STATE DEPARTMENT OF HEALTH,
<br /> ',1:ii,FW U OFrcL---STATISTICS, WHICH IS THE LEGAL DEPOSITORY_
<br /> Nr.itAi.- 4o0ba. /
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<br /> DIRECTOR OF ITAL S ATI•TICS AND ASSISTANT STATE REGISTRAR
<br /> LINCOLN, NEBRASKA -----
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<br /> State of Nebraska 1.
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<br /> CA3unty of Hall
<br /> Entered on IN.Tornerica: Indzx and filed
<br /> for record in Cffce of Register of
<br /> Deeds on the __ V day of
<br /> at
<br /> o'clock na ,-40 _. minutes _.e.,__M.
<br /> and 1,_-c,,,...itd in Book 1/43
<br /> of
<br /> 226 tztaze... .:.4i. ..... ,I
<br /> Register of Deeds
<br /> By........ ..e.
<br /> 6-- Deputy
<br /> Fees kg--:-.....— i
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