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<br />LOT 7, BLOCK 5, IN COUNTRY CLUB SUBDIVISION BEING A PART OF THE E 1/2 NW 1/4
<br />OF SECTION 28, IN TOWNSHIP 11 NORTH, RANGE 9 WEST OF THE 6TH P.M., HALL COUNTY,
<br />NEBRASKA.
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<br />WHEN TWS COPYCANWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIOVIAL RECORD_ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL MT/CS SECTAN, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS =
<br />DATE OF ISSUANCE
<br />20011 3 4 8 2 ANLEYS. COOPER
<br />DEC 14 2001 ,vSSISrANT SIATIc aE ISTRAR
<br />LINCOLN, NEBRASKA HEALTH AMD HUMAN SERViGE YSTEM
<br />STATE OF NEBRASKA— DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS p � O
<br />CERTIFICATE OF DEATH - , �, O
<br />DECEDENT -NAME FIRS MIDDLE LAZ I six DATE Oi DEAN (Me D., y,) —
<br />I Donald Eugene Smith 7Male July 27,1983
<br />RACE -(e y., wAiee, Rlet►, ,VerKew �I(- .1W0ExENT(w.y., hollow, M4aicow, AGE -Iwr R:wye� UNDEIr 1 YEAR' UNOEt 1 DAY DATE Oi tIRTN
<br />Iwd:ew, ef.1 fSp�IY: to Gr.�w. Nt.l lSpetripj (Yn.1 59 "CIS. DAYS' HOI:RS . AUNS
<br />t. j OF , American p eo �� � �, March 5,1924
<br />CI AND STATE OF RIRTH (if wet rw U.S.A., CITIZEN OF WHAT COUNTRY MA RIEO, NEI�VnEuR� eM�ARRIED, I NAME Of SPOUSE (N-, -.
<br />wewa sww j WIDOWED. DIVORCED(Spwfr) Ri^ wro:dew worwel �.
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<br />LOT 7, BLOCK 5, IN COUNTRY CLUB SUBDIVISION BEING A PART OF THE E 1/2 NW 1/4
<br />OF SECTION 28, IN TOWNSHIP 11 NORTH, RANGE 9 WEST OF THE 6TH P.M., HALL COUNTY,
<br />NEBRASKA.
<br />CJ\
<br />q�,J\
<br />WHEN TWS COPYCANWS THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, R CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIOVIAL RECORD_ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL MT/CS SECTAN, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS =
<br />DATE OF ISSUANCE
<br />20011 3 4 8 2 ANLEYS. COOPER
<br />DEC 14 2001 ,vSSISrANT SIATIc aE ISTRAR
<br />LINCOLN, NEBRASKA HEALTH AMD HUMAN SERViGE YSTEM
<br />STATE OF NEBRASKA— DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS p � O
<br />CERTIFICATE OF DEATH - , �, O
<br />DECEDENT -NAME FIRS MIDDLE LAZ I six DATE Oi DEAN (Me D., y,) —
<br />I Donald Eugene Smith 7Male July 27,1983
<br />RACE -(e y., wAiee, Rlet►, ,VerKew �I(- .1W0ExENT(w.y., hollow, M4aicow, AGE -Iwr R:wye� UNDEIr 1 YEAR' UNOEt 1 DAY DATE Oi tIRTN
<br />Iwd:ew, ef.1 fSp�IY: to Gr.�w. Nt.l lSpetripj (Yn.1 59 "CIS. DAYS' HOI:RS . AUNS
<br />t. j OF , American p eo �� � �, March 5,1924
<br />CI AND STATE OF RIRTH (if wet rw U.S.A., CITIZEN OF WHAT COUNTRY MA RIEO, NEI�VnEuR� eM�ARRIED, I NAME Of SPOUSE (N-, -.
<br />wewa sww j WIDOWED. DIVORCED(Spwfr) Ri^ wro:dew worwel �.
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<br />LIMITS
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<br />Smith _i„ Gertrude C.
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<br />August brand Island
<br />iTION CITY OR TOWN STATE
<br />,josedale, Nebraska
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