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<br />to the City of Grand Island] hall County, Nebraska.
<br />WHEN THs COPYCARRESTME RAISED SEAL OF THE NEBRASKA HEALTH AND HOMAN SERVICES
<br />SYSTEM ITCERTFES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ONFILEWITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS / FT
<br />DATE OF ISSUANCE 2 0 0 4 0 0 4 21 NL lS. COOPER
<br />DEC 19 2002 STATER COOPER
<br />L MD HU AN STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
<br />STATE OF NEBRASKA- DEPA]k h OF utu.THMID HUMAN SERVICES PENANCE AND SUPPORT
<br />VFTALSTATISTICS „
<br />_ � CFRTIFTCAT 02 13704
<br />F OF MEATH
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<br />John Ross
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<br />November 14 2002
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<br />John
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<br />IS YEA, DECEA6E0 E°EF IN VS ADDED TORCEE? VjCtEl3B rna INFOPMPNi NPME -
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<br />Yes I October 7, 1961 /A T�,� 9, 1962 Marlyn miller. _.. _..-
<br />AP INFOOMANT EIRwrvcmo6ESS TsmE6r6AD O NO CUYUR TOWN N TF EIR
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<br />WHEN THs COPYCARRESTME RAISED SEAL OF THE NEBRASKA HEALTH AND HOMAN SERVICES
<br />SYSTEM ITCERTFES THE BELOW TO SEA TRUE COPY OF THE ORIGINAL RECORD ONFILEWITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS / FT
<br />DATE OF ISSUANCE 2 0 0 4 0 0 4 21 NL lS. COOPER
<br />DEC 19 2002 STATER COOPER
<br />L MD HU AN STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM
<br />STATE OF NEBRASKA- DEPA]k h OF utu.THMID HUMAN SERVICES PENANCE AND SUPPORT
<br />VFTALSTATISTICS „
<br />_ � CFRTIFTCAT 02 13704
<br />F OF MEATH
<br />Ir OFCEOfxi -xnmf Fln9 uiODIE
<br />a SEX
<br />OF OEA
<br />John Ross
<br />Male
<br />November 14 2002
<br />4 , v[ex uxOEO�O ♦v 6 M
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<br />ryrrl EATS E, .56. MIGrand
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<br />12 4 _
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<br />NEY,CR- ,In..1 DIWIF MAIDEN SURNAME
<br />Samuel iffller
<br />John
<br />Lois Ada Rasp
<br />IS YEA, DECEA6E0 E°EF IN VS ADDED TORCEE? VjCtEl3B rna INFOPMPNi NPME -
<br />Rl S11— ,- auesa.'PiNv
<br />Yes I October 7, 1961 /A T�,� 9, 1962 Marlyn miller. _.. _..-
<br />AP INFOOMANT EIRwrvcmo6ESS TsmE6r6AD O NO CUYUR TOWN N TF EIR
<br />,417 Linden Ave., Grand Island, Nebraska 68801
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<br />2929 S. Locust St., Grand island, Nebraska-68801
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<br />31 iw, i AI1DADDRESS OF CERTElon I Ixm6LY♦N. conDNF" s NFYUCUw on cwxTY ATTRENTO r�u Emml
<br />Sitki M. Copur M.D., 2116 W Fa_id a Ave. Grand Island, Nebraska 68803
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