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WHEN TH/SCOPYCARRIES THE RAISED SEAL OFTHE NEBNASKAHEALTH ANO HUMAN SERVICES
<br />SYSTEM, ITCERTFIES THE BELOW TO BEA TRUE COPYOF THE ORKNNAL RECORD- OHFa:EWTTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVCES SYSTEM. VITAL STATISTICS_SECTIVICONICHIS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />ANLEYACOOPER
<br />SEP 18 2002 --
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEAT _
<br />200210766
<br />STAR OF 11910AM -00MU TBR OF "MTN
<br />elARA00F TSFAL OTAtISM 84 1169
<br />CERTIFICATE OF DEATH -�. sas 6
<br />lsmetIl itendell JeIleson
<br />October 10 1984
<br />l IY w wmlr..sr.T. •..r
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<br />LEGAL DESCRIPTION: LOT
<br />13, BLOCK 9,
<br />PARKHILL THIRD
<br />SUBDIVISION,
<br />AN��
<br />ADDITION TO THE CITY OF
<br />GRAND ISLAND,
<br />HALT,
<br />COUNTY,
<br />NEBRASKA.
<br />WHEN TH/SCOPYCARRIES THE RAISED SEAL OFTHE NEBNASKAHEALTH ANO HUMAN SERVICES
<br />SYSTEM, ITCERTFIES THE BELOW TO BEA TRUE COPYOF THE ORKNNAL RECORD- OHFa:EWTTH
<br />THE NEBRASKA HEALTH AND HUMAN SERVCES SYSTEM. VITAL STATISTICS_SECTIVICONICHIS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />ANLEYACOOPER
<br />SEP 18 2002 --
<br />ASSISTANT STATE REGISTRAR
<br />LINCOLN, NEBRASKA HEALTH AND HUMAN SERVICES SYSTEAT _
<br />200210766
<br />STAR OF 11910AM -00MU TBR OF "MTN
<br />elARA00F TSFAL OTAtISM 84 1169
<br />CERTIFICATE OF DEATH -�. sas 6
<br />lsmetIl itendell JeIleson
<br />October 10 1984
<br />l IY w wmlr..sr.T. •..r
<br />�oor�,.rll>hIM1F•
<br />1,/1,,. wJlf,«i1H n..l nq. w
<br />Ylite ATrriean 61 61 21 1 3
<br />,
<br />1 .L U.
<br />Is.Ny) Clark
<br />Webraska O.B.A. ID arrie
<br />socus uerteuN.n acurAnwfpNw -.A Ar, .,w .Ym w wwnTn c nMMN
<br />�M�r �w�,YN.NI /l
<br />T 3 Iaem+nee Bat 1
<br />I..50T- 12 -2T33 w. s�aee.s' 1
<br />cm. TDWNgwuTSo-sawTR Ylwwcyym'ulurs Imnyu�ss�nlosYawminlDn -rr nNl.,.L,,. +Nmr aYm rY.w oD..
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<br />HIrYrIel,s.l W C7Wr s A
<br />Grand bland, IabraW 1 ,..
<br />Ir.
<br />nslD.NCf -n.n caulnY an,soWN wsourgN smnWa wwsn INnDl
<br />rsr.. TrrN.r
<br />Ieland IM. 04 li Olslabar w. ee
<br />I» IS• )
<br />AMU
<br />Jo Il Tobnmon IOQ Peterson
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