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1 <br />89-pm, 10393' <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE <br />DEItARTKMT OF HEALTH, IT CERTIFIES THE BELOW TO BS_A.TFUF COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPRiTld*i•Qh HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL RIMITORY r(M. <br />VITAL RECORDS. <br />DATE OF ISSUANCE <br />JUL Z 7 IM STANLEY S CM XR;., D TdR <br />LINCOLN, NEBRASM BUREAU OF VITALFT"TICS <br />i .. <br />i <br />:TATS OF M MQA —MA KIff OF MMIN <br />VJMM OF MAL:TATISMS 7F 0925-7 <br />CERTIFICATE of DEATH <br />M_ <br />A a AT" (me... bij. r..) <br />idn" <br />solu• •hs <br />F•aa s <br />12 Mont 12 1978 <br />- N.e.. <br />so1�j, <br />3t• <br />ti <br />iCINTN.e..MU...Yw(a•. <br />.11.11s,.1+r1 <br />s�man (� <br />!- �..Mn.�► <br />fVw.l <br />78 <br />1 rlA� <br />1 OAr DAt! eMTNf+1M. WS.r•.► <br />"mid; SAWS <br />, Ma=h 209 1900 <br />mos. DAYS <br />urvemv t4ma NAME OF�f . ti*..A,Pi.. �w) <br />wn�o�olMOe ED(s,«ay, BtLahard B. hs', d•0. <br />`'a'und Ialst�d, Y•. . U. S. A. t t. ' �. ) <br />ssocuawcar" UMOM UMMOCCUPA YMN(Gw. WSW 91~6fw*""A.M. RI4'WaWLNtisOe(NDUSTA'f COYNTrOfOtAl'": ' <br />t Sim .59 2577 �..•H t �..••_ :Net") Paz 'ray $oa•maki ng <br />O{l� 1M�1"IDIIC1TY <br />CITT,TOIMIlfie 11011 CSN111N <br />1 ihc" Island <br />R Nce -sulm COUNTT <br />Is.. 1st. <br />WTi IWiMTAIORO IR/R4S974t(ON- Now (Nooi**i6w. •NOt►Qn�r�{��.i..w <br />(sod r« «N.) Aiww�e a a'' owww•pti... ■►. :..a...•I,A.d•l <br />t� t•B tw illt ��A'�.QZ HOB . ts. <br />CIMTOVM04WCANON sTIMUN ONUMeIl. M. Kw..N.) <br />ts• 1SI. <br />rA.w.. -.ww ..... �...... •-- --- - -.-�— <br />,� w 1142 i a� »_ �' <br />° WAS OlCt4M EVER IN U.s. AM M TOERSI OMNAA 1NT- MAW- p1A ►lOMS1l/- A{AtlM1O ADM" <br />)e. n0 no ».tMth •hs�ca-Rt. 1 Ga <br />•U&MU c•...1+.., VA19 04m m► On C419AMTOlT - "ME u <br />sv: - ?6-7R Pa <br />& <br />- !,C TUNIeM 11011E - MAME A1i0 AOellSS gtlllT O! v <br />1820 Idvinmto�Saad s�Ba�u,505 tit <br />mw. doft wd all <br />no <br />• l' <br />►eONOVTIClDDo <br />l MN p y,1, A►• r•J ± fma.. Day. Vt.) <br />/ %L <br />An <br />tt /l 011.. /.0. 90.;MClTOWK iTA►L !N1 <br />N�. 65624 - <br />CmOEIOwN STATE <br />Geend Island. ]I•. <br />.m OA TOW1. VATL M <br />1gs Mmud Imlaad,N•.6M ' <br />�eOTWUNCE00lAD11N�r , . <br />w <br />mm TO. mAl:A.00laflaudwe OU <br />I <br />