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<br />WHEN NIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT
<br />CERTIRES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD
<br />ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE
<br />7/7/2021
<br />LINCOLN, NEBRASKA
<br />20211063i
<br />344eti,
<br />Sarah Bohnenkamp
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEALTH)
<br />AND HUMAN SERVICES
<br />STATE OFTIEIOASIA-11EPA1TIODFT OF INEALTO
<br />MAIM OF VIVO. STATISTICS
<br />CERTIFICATE OF DEATH 8(; 04 6513
<br />nommere mom assormrtAS or moo
<br />Ducsald Louis Eossi.cici
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