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- . ' ,� STATE OF NEBRASKA <br />�012U9�4:.`� : <br />WHEN THIS COPY G4RRIES THE RAI5ED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTl1:4ND H MLtN SERtII=E'S, IT CERTIFIES <br />THE BFLOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKAypb�,4��h�E`� H�4�TH A/VD <br />, HUMAjfV SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR -V1TAL ( p � E�k1jS" '�'�� <br />= r C 4�� <br />, DATE OF ISSUANCE ,������!��� 6 : � <br />� � � f�: - <br />STr�N� S; COOPE� ;� , � � <br />�C� �� ��9� . AS;ISTAN'T,�' E ; Y ^ <br />D��' � �' <br />, LINCOLN, NEBRASKA • Ht1M�l SER!/ICE� .: -� �° r ' <br />• � ': .,� � �- - • .-r� � <br />,z o � <br />� �� . e ���� � r <br />�� s'�����R1�•���� �? <br />. <br />3TATEOFN�RASKA—DEPARTMENTOFHElU.THAWQt1UMANSERYtCEBFlNANI�Af30�8U� �'e�.�� •�;� � � <br />CERTIFICATE OF DEATH ' • " �w� <br />� 1.DECEDENT'9•NAtdE (�N. Allddle. L�st. 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HAS DRGAN OA TISSUE DONATlOAI BEEN CAN&IOGAED? I 28b. W1V9 �!R E 7 <br />Buf f alo <br />N• <br />� NO . � Nat Appike6la d 76a b t10 0 tE3 C] � <br />fYA1T4RNET) {ryp�mPrinO . i ": � � � � <br />Attorney, PO Box 67, Kesraey NE 68848 <br />� <br />� sBD.DATEFLLE08YHE41ST9AR (61o..0ar.Yti� <br />�ev � DEC 7 2007 <br />w�s� »ro3cssoeu <br />0 <br />