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<br /> WHEN TFlIS COPYCAF�iES TFE RAISED 3EAL OF THE NEBF ASKA HEALTH AND HUMAN��ES ` �
<br /> SYSTEII�IT CERT�IES TFE BELOW TO BE A TRUE COPY OF THE ORIG/NAL�COR�i11FlL�N�:__ ' ��\
<br /> THE NEBRASKA NEALTH AND HUMAN SERVICES SYSTEM,VITAL STATISTICS SE-�TI�IF,�W�"IhCR�-':. �
<br /> THE LEQAL DEPOS/TORY FOR VITAL RECORDS -- - - �
<br /> DATE OF lSSUANCE �—�� � - `
<br /> ��������E'�`��E14 : _ ==
<br /> NOV 1 0 1999 ass�sTanr€s�r�`��r�r�'r.-:= _.� '
<br /> LINCOLN,NEBRASKA HEALTHAND HUMAIIF�ERiIJC�$SY$�A�' _�^
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<br /> LEGAL : Lot Seven (7) , Block Six ( 6) , �'arkhil�- ����o-n�i=== - ,
<br /> Subdivision, City of Grand Island, Hall County�;�`�-aska .
<br /> STATE OFBUREAU OF VI TAL S7ATISTICSF MEALTH ~ p /; � 1 L � �'`I
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<br /> CERTIFICATE OF DEATH �__, .�
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<br /> Laurence Reger Davis __ October 9, 1994
<br /> Male
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<br /> Nebraska Hall Grand Island 2315 W. Anna 68803 � Y..(X� �❑
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<br /> t7 Iq111ER FWSI MIDOI! N/NDFNSUW�PME
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<br /> 2315 W. Anna, Grand Island, Nebraska 68803 __
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<br /> Gordon J. Hrni�ek M.D. 729 N. Custer, Grand Island, NE. 68803 _ __ ___
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