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202504967 <br />STATE OF NEBRASKA <br />WHEN THIS COPY CARRIES THE RAISED SEAL'OF THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, IT CERTIFIES <br />THE BELOW TO BEA TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND <br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS,„ <br />DATE OF ISSUANCE <br />APR 112011 <br />STANLEY S. COOPER <br />ASSISTANT STATE REGISTRAR <br />DEPARTMENT OF HEALTH AND <br />LINCOLN, NEBRASKA HUMAN SERVICES <br />STATE OF NEBRASKA. DEPARTMENT OF HEALTH ANO HUAAN SERVICES <br />I.OECECENRINWE MINA MARK LPµ SARIN <br />Anastasia P Jamson <br />2. SEX <br />Female <br />S. DATE OF DEATNNM..,.Trj <br />Apri 1. 2011 <br />tart AND STATE OR TERRITORY. OR MOM COUNMY OF RUM <br />M. ADLLaat DMelm <br />SE. mow I YEAR <br />SaUDER 1 DAT <br />L DATE OF MAMMA DAL WI <br />City, Missouri <br />STa•) <br />80 <br />ROa <br />OATS <br />HOURS <br />AIMS. <br />July 16,1930 <br />r. 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M{�1N (DENMrF MCTm.) <br />. <br />E <br />Si."'IRolloudreas <br />OMDawaad.NNd.Nbw.tlari <br />NMENr.aN.mapass MMw <br />m <br />a MN««M imed. �gnao NP M4 MAR <br />2s. <br />YES <br />ale OONTRwmiD OEATMI <br />�No OPRORARM ❑UNRHOMI <br />Efs. 14AS 0.414110/11111SUI MINA racy SommeariEo, <br />DYES ► <br />YaeeoNmn SaA,nD7 <br />HM .RNMIAS maw so pvas IS .ND <br />22ANNE•MLR AND ADORES! Of CERTIFIER IPnSICIAMPm'NCIAMA$SISTANT, OR Camay ATTOII.KYI(WIN W PAW <br />John A wagoner M.D. 800 Alpha Street Grand island N8 68803 <br />MA AweIRARS MORATUAR ,( <br />it J A'' <br />aA DATE Faso ay SEC TSAR Na. Dm. W) <br />APR 7 2(H) <br />