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<br />WHEN THIS COPY CARRIES THE RAISED SEAT. OF THE NEBRASKA" STATE
<br />11 DEPARTMINT OF HEALTH. IT CERTIFIES THE BELOW TO DE A 1.
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<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DZPAR1'�11 t ;, !� ,
<br />BUREAU OF, VITAL STATISTICS. WHICH IS THE LEGAL DZP*F!! Wr.
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<br />VITAL RECORDS.
<br />!I DATE OF ISSUANCE
<br />MAR 8 ON STANLEY 17. -,
<br />4. LINCOLN, NEBRASKA BUREAU OF VIxAL�'LS�
<br />STATt W IMMAWA- NfANOWR V NMTH
<br />MOM OF WTAL UATfSM
<br />CERTIFICATE OF. DEATH ', -
<br />ter= Now
<br />Me ►gaud Laurltz .. _ Jensen Mmie.: February. 4,. 1�$9
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<br />Thoiaas C. Jensen 1? Ida S. Larsen_
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