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4/17/2012 11:35:20 AM
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4/16/2012 4:27:40 PM
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008-606
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0/0 ` <br />It <br />7 <br />I)EPARTNIEN , 1, P�-nl IC HEALTH, <br />STATE OF NEBRASKA <br />DEPARTNIENT OF HEALTH <br />EDI CA TION AND ELF ARE <br />Butv,au of Vital Statisti" <br />BIRTH NO 126 <br />CERTIFICATE OF DEATH STATE FILE NO <br />T' <br />2 USUA, 6.c0UNTY <br />o IT T1 <br />..RF,IC NF <br />—.1 <br />e <br />CFc,D <br />IC DTN l•, IN III <br />I CITI.I.WN.OR L-111" <br />T—All <br />2 <br />I ITFIIT iDD.ISI <br />It <br />B <br />0 <br />Issued February 1, <br />I, �. <br />cuLl * , <br />f FARM RESIDENCE' YES <br />ES <br />No 13 <br />XAT" ji <br />..RF,IC NF <br />'A" AD, IN I. A <br />'I <br />4"' <br />CFc,D <br />�d <br />7-- <br />73 <br />T—All <br />2 <br />--ULr- <br />iiLrie Euve <br />Add,, <br />I-. IS' SOCI•L S[CJPITY NO <br />1) IN[OI)YANT ie. r <br />T" ..d 10 <br />1=11AL IIIETWEEN <br />IT <br />We <br />C,1 To 1n. 4' c? <br />'I.- A, <br />... ..... . <br />TIW- <br />2 7 <br />V .1d I..' <br />-7 <br />r <br />RARE 01 <br />'it <br />JA <br />B <br />0 <br />Issued February 1, <br />I, �. <br />
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