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WHEN THISCOPYCARRES THE RAISED SEAL OF THE NEBRASKA HEALTH AND NUMANSERVICES
<br />SYSTEM, RCERT/FIES THE BELOW TO BE A TRUE COPYOF THE ORIGINAL RECORD ON FB ff WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTIC9 9tOTION, WNiCH.IO
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS.
<br />DATEOFISSUANCE { { 129
<br />COOPER-
<br />MAY e2002 2002063 A99I A�,
<br />LINCOLN, NEBRASKA HEALTH AND HTINAN SERWOES SYSTEM
<br />STATEOFNEBRASKA- DFYAKTFIcNTOFIff .ILIHANDHUMANSERYIMFWANCSANOSU RT
<br />SAL STAns„Ds 0 2 05234
<br />CERTIFICATE OF DEATH
<br />• 2 SEX
<br />DENT .NAME "° -� D.
<br />nd C• Cl April 30, 2002
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<br />I CITY AND STATE u1A Mre. n E ov r^ ^N^r +^>r
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<br />Cage County, Nebraska 80 November A 1921
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<br />F.H. ❑`""'°” ❑ _ Cairo, Nebraska
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<br />III DATE OF DEATH rMV. S nr — _-
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<br />TIME Al OU x
<br />April 30, 2002
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<br />31 NAME AND ADDRESS WC Tun Rv.+ICUn ITIDDENTFATTORTNEY,
<br />800 Al ha St rand Island NE 68803
<br />Dr Ryan Crouch, MD -. _F1 My
<br />xLLrsrP,w r
<br />nm onrEF. AfFECISTRAH E. DAM
<br />1 MAY 7 2002
<br />RE: Lot Three (3), Block One (1), 8th Addition to Cairo, Hall County, Nebraska.
<br />
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