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<br />STATE OF NEBRASKA- DEPARIRffifl OF MMIETI AND MAUEN SERVICPR iDUNCO AND SU RT
<br />CERTIFICATE OF DEATH 200214006
<br />FOR VITAL STATISTICS USE ONLY
<br />NSC
<br />............................... Pan IL....................TMV
<br />I hereby certify this to be a true and correct copy of the original
<br />fiIId withla State of Nebraska
<br />JZ <uy� -tom s
<br />Signed in by
<br />Sign is --11-&A day of Jlli 1—
<br />Notary Public 05 fi N
<br />�' VIY LYIrv(II
<br />Tract No.
<br />E DE REAR, A-. D., ..w
<br />Marvin Roe Falin
<br />Male
<br />September 27, 2001
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<br />March 27. 1918
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<br />4335 Calvin Drive 68801
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<br />»D mMary
<br />William„ Roe Falin
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<br />601 N. Webb Road, Grand Ialand, Nebraska 68803 -4050
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<br />EEILED[rnEweT P.P REA nr. ,,r
<br />FOR VITAL STATISTICS USE ONLY
<br />NSC
<br />............................... Pan IL....................TMV
<br />I hereby certify this to be a true and correct copy of the original
<br />fiIId withla State of Nebraska
<br />JZ <uy� -tom s
<br />Signed in by
<br />Sign is --11-&A day of Jlli 1—
<br />Notary Public 05 fi N
<br />�' VIY LYIrv(II
<br />Tract No.
<br />
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