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BIRTH NO. 126.... <br />M=TE OF NEBRASKA <br />DEPARTKMT OF HEALTH <br />Bureau of Vital St&tJstks <br />CERTIFICATE OF DEATH <br />1. PLACE OF �T. <br />I. SUAL RESIDENCE JWb— <br />Lmutwumz <br />COUNTY <br />WWW-). <br />xwso VL <br />L CITY ­9-4 11,1u, —k* R—d) 1 c. LENGTH <br />CITY I If or'lade ecrI—to QWt� ;Mte RURAL) <br />STAY <br />A I <br />02 <br />TOWN TO <br />AM <br />4. FULL NAME <br />VOSPITA <br />1�� <br />insut-k— <br />d. STREET <br />ADDRESS <br />'71Mh <br />IN <br />16t <br />1, NAME OF <br />1. <br />w1m) <br />4bATE (Montb) (Day) (Y-,), <br />OF '21 <br />• <br />