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<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COpy
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL RECORDS.
<br />
<br />DATE OF ISSUANCE
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<br />ST~t~yl~:__ =G~~~ ,-iD~REGTOR
<br />BURhy>~viTAVSTAiISTICS
<br />l ,- ."'- ,. --'---- --
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<br />JAM 271993
<br />LINCOLN, NEBRASKA
<br />
<br />200608475
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<br />dTATE OFNEBRASK.;':[)EPARTMENT OF HEALTlI
<br />a_re... 01 VI'" Sa.II.aaea r
<br />CERTIFICATE OF DEATH q. Jj"
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<br />72 12200
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<br />DATI Of DfAnt . "OM''', "'Y, .....,
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<br />1 Ootober 6, -1972 ---.-
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<br />COUNTY or EllA'"
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