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<br />WHEN THIS COPY CARRES TFE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEII4 R CERTFES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATIS,TIC£890% � MMCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />DATE OF ISSUANCE 71 -
<br />ANLEY S. COOPER .
<br />OCT 1, 8 2004 2 0 0 4 1 14 5 9 HEALTH
<br />LINCOLN, NEBRASKA
<br />STATE OF
<br />, rvkd s186111" � '77 01897
<br />CERTIFICATE OF 'DEATH.
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<br />1 DEATH WAS CAUSED tY. �HAER On1r O►rE CAUSE ►EII Leal FOIL (al. I6). AND kA
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<br />1L„Trans rtation
<br />Su rintendent Is Construction
<br />WSOMCE —STATE COUNTY
<br />CRY. TOWN. OR LOCATION NOW Caw teens
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<br />1 DEATH WAS CAUSED tY. �HAER On1r O►rE CAUSE ►EII Leal FOIL (al. I6). AND kA
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