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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUAAW SERVICES
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RCCORIO*W WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTI S:S OjW-, fl0H IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. 3
<br />DATE OF ISSUANCE
<br />FEB 12 2001 _ EY -
<br />ASSISTANT STATE WCUSTW It
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
<br />200101848
<br />STATE OR NEBRASKA — MARTUDR OF HEALTH
<br />BUREAU OF T1oFOEATM 1,\ ) ,- - ) 92 13007
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<br />DATE of NAJAY Aft.00A Y1`.)
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUAAW SERVICES
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RCCORIO*W WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTI S:S OjW-, fl0H IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. 3
<br />DATE OF ISSUANCE
<br />FEB 12 2001 _ EY -
<br />ASSISTANT STATE WCUSTW It
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
<br />200101848
<br />STATE OR NEBRASKA — MARTUDR OF HEALTH
<br />BUREAU OF T1oFOEATM 1,\ ) ,- - ) 92 13007
<br />t FIRST me" LAST
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<br />June 18, 1914 {{
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<br />Bu Nov. 21, 1992 St. Petzrs Cemetery Fullerton+ Nebraska
<br />''//d V FUNERAL HOME - NAME AND App1E6S ffiREET DR III D NO CrtY CIA TOWN ST 41L zw" 68801
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<br />DATE of NAJAY Aft.00A Y1`.)
<br />HOUR OF NAWY
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<br />OR FETOINO INVESTIGATION 00001w
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<br />22R DATE F" ED BY REO1SI RAR __ Dry, r. t
<br />NOV 2 5 1992
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