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ffliEN TM COPY CAARES TM RAISED SEAL OF THE NESA A SKA HEAL IN AMP HUM" SERVICES
<br />SYSTEM; fr CERTMES TIC BELOW rO BE A TRUE COPY OF THE 0Rt0X4LREMfM ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERYKES SYSTEM, VITAL STATISTICS SEC170k WHICH IS
<br />THE LEGAL DEPOSrrORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />OCT 2 7 1999 VAIVU WCOOPER
<br />ASSIS"IANTSTATEREGISMAR
<br />LINCOLN, NEBRASKA HEAL THANOMMAN SERVICES SYSTEM
<br />STATE OF NEBRAM- OVARTNEUT Of HEALTH
<br />Ali. Of VITAL STATISM 80 14042
<br />CE.F.9iFICATEN DEATH jj).,j,jn I
<br />UZINNI-NA"i ---PAT A= LOUT
<br />TA 7M., 5;;7 W4
<br />1loyd Arthur weach
<br />Male
<br />December 31 1980
<br />An -1
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<br />I DATE Co, SWTH (A4&, 0&y. Yt.)
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<br />ffliEN TM COPY CAARES TM RAISED SEAL OF THE NESA A SKA HEAL IN AMP HUM" SERVICES
<br />SYSTEM; fr CERTMES TIC BELOW rO BE A TRUE COPY OF THE 0Rt0X4LREMfM ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERYKES SYSTEM, VITAL STATISTICS SEC170k WHICH IS
<br />THE LEGAL DEPOSrrORY FOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />OCT 2 7 1999 VAIVU WCOOPER
<br />ASSIS"IANTSTATEREGISMAR
<br />LINCOLN, NEBRASKA HEAL THANOMMAN SERVICES SYSTEM
<br />STATE OF NEBRAM- OVARTNEUT Of HEALTH
<br />Ali. Of VITAL STATISM 80 14042
<br />CE.F.9iFICATEN DEATH jj).,j,jn I
<br />UZINNI-NA"i ---PAT A= LOUT
<br />TA 7M., 5;;7 W4
<br />1loyd Arthur weach
<br />Male
<br />December 31 1980
<br />An -1
<br />(Y-j
<br />Uw"I I "-#A I
<br />UWE* I OAT
<br />I DATE Co, SWTH (A4&, 0&y. Yt.)
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<br />01
<br />40, 69
<br />W 16kt.
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<br />"av;n[6 - , - , i,
<br />I I , . I . M_oy)
<br />so, abraska U.S.A. Karg Bret' L: Naylor
<br />K
<br />so wcuorn I W I M 0 C C U 0 A T X W (CR 0 0 k io 0 4 •11 w wk t%" i I a r _51
<br />KAIN
<br />of*41AARS A4. #room$)
<br />Carpenter 14.. Hall
<br />, qq1ofte.
<br />CITY, TOWN M LOCATION W DEATH
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<br />gave CM WAM
<br />hod MAL oa CnHi* Wann".- 50*014046w,
<br />#sow.
<br />*"QW. *W,1.�PGA.
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<br />ISTUIET 06 RFA "o. CM C4 VOWK SIATIL LIM
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<br />DATED DCATH Wp� PP7. yr.)
<br />_'f'T_ArnT0dN
<br />PHTUC" 5F75UN
<br />R.I. Zoefcw)t M.D. 727 X. Custer, Crand Island. HE 68801
<br />INto by k1dis A6.1
<br />CAJJM
<br />AP40 (0)
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