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<br />L�NliEti THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />,1109PA•RTHENT OF HEALTH. YT CERTIFIF ► 711R BELOW TO BF' A TRITE COPY
<br />1 -OF AN ORIGINAL RECORp ON FILE WITi1 SHE STATE DEPARTMENT OF HEALTH
<br />';jBUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL. DEPOSITORY FOR
<br />3 -VITAL RECORDS.
<br />4DATE OF ISSUANCE
<br />!� AUG 3Q 1490 STANLEY S. COOPER, DIRECTOR
<br />;LINCOLN, NEBRASKA BUREAU OF VITAL STATISTICS
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<br />STATE OF NEe11ASKA — MPARTMENT OF HEALTH ^ 14,393
<br />ROM OF V17AL STATISTICS J
<br />CERTIFICATE OF DEATH
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