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WHEN THIS COPY CANNES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUM"WRI?CES
<br />SYSTEM, RCERTIRESTHE BELOWTO BE A TRUE COPY OF THE ORIGINAL RECOR ONFllP WTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STA7IS1ICBS6CI1ONWMC4HHS.
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />200305785 �P
<br />MAY 2 2001 As3IST414TSTAT REG R
<br />LINCOLN, NEBRASKA HEALTHANOHUMiNSER19CE3SYSTE6T ='
<br />STATE OF NEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SMWSS FTNANCJvAKD SIIRfl_ RT
<br />VDAL STATISTICS _ _ qq
<br />CERTIFICATE OF DEATH i 04445
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