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� <br />.' <br />` '-------------------'-' | <br />� <br />' ^ <br />| <br />| <br />NEBRASKA (STATE) IDEP OF EMALTH <br />Bureau of Vital tistice <br />STANDARD CERTIFICATE OF DEATH <br />FEDERAL SECURITY AGENCY <br />U. S. PUBLIC HEALTH SERVICE <br />OF DEA USUAL RESIDENCE DECEASED: <br />1. PLACE <br />z if nle-iltt-lr t.,. 11,cit, —itc XURAIj W City —1 <br />and .. d occurred on the date and be. stated W.- <br />IED <br />th VC2�A <br />(State "Ien, <br />14. N 22. If doeth wee dua W external mvcaa� fill in the followings <br />� � <br />� U -- ~- || <br />� 0~ � | <br />� <br />' <br />' <br />.. <br />' <br />«° <br />�-� . <br />