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WHEN na Ce"URRES TEE RAISEO SEAL OF THE NEBRASKA NEALTHANU HURIAN-9EMVICES
<br />SYSTEM RCERIIRES RE BELOW TO BE A TROECOPYOFTHE ORIGINAL RECOROONFILEWrH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTNiS AWTION, WNIGHIS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS A I `.1- -
<br />OATS OF ISSUANCE NAME,EB COOPER
<br />OCT 16 2002 AS , S1STAATZrAMW9OFStRAfi
<br />LINCOLN. NEBRASKA .11ALiHAND HUMAN SER>n S33YSTEN:
<br />200211825
<br />STATE OF NUIRAS"
<br />BUREAU G - OEPARTNENT OF HEALTH 94-00910
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<br />WHEN na Ce"URRES TEE RAISEO SEAL OF THE NEBRASKA NEALTHANU HURIAN-9EMVICES
<br />SYSTEM RCERIIRES RE BELOW TO BE A TROECOPYOFTHE ORIGINAL RECOROONFILEWrH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATISTNiS AWTION, WNIGHIS
<br />THE LEGAL DEPOSITORYFOR VITAL RECORDS A I `.1- -
<br />OATS OF ISSUANCE NAME,EB COOPER
<br />OCT 16 2002 AS , S1STAATZrAMW9OFStRAfi
<br />LINCOLN. NEBRASKA .11ALiHAND HUMAN SER>n S33YSTEN:
<br />200211825
<br />STATE OF NUIRAS"
<br />BUREAU G - OEPARTNENT OF HEALTH 94-00910
<br />BEAU MAL STAnSeCS
<br />CERTIFICATE OF DEATH \ , "(. ✓.
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<br />!January
<br />Rosemary Rock Werner
<br />Female
<br />28, 1994
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<br />1405 S. Harrison 68801
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<br />William Werner
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<br />,. vrvo-N.
<br />rSt.
<br />Kleine Funeral lime
<br />❑� ❑�
<br />Libory, Nebraska
<br />•3213
<br />W. North Front St., Grand Island, Nebraska 68807_
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