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<br />Ie.ln <br />fl'f'( O~ PlfNr IN <br />PflMANINT INK <br />.U INsrlUC hON <br />MANUAL <br /> <br />c...__....,.. <br /> <br />r <br /> <br />cc..u...... <br /> <br />STATE Of NEBRASKA-DEPARTMENT Of HULTH <br />BUREAU Of VITAL STATISTICS <br />CERTIF!CATE OF DEATH <br /> <br />87- 107092 <br /> <br />DECfDENt NllMf <br /> <br />""ST <br /> <br /> <br />MIDOlf <br /> <br />lAS' <br /> <br />DATE- Of Of AI" (/tAQ.. Oor. ",..) <br /> <br />Irk44.........._......... <br /> <br />CCI.........,...,..__., <br /> <br /> <br />II <br /> <br /> <br />1.,.--,...,........,.., <br /> <br />,us Tr I <br /> <br />L <br /> <br />a.M <br /> <br />i~ <br />..~ <br />"-z <br />..u. <br />!Vi.O <br />{f~ ... <br />~~i' <br />J:r:> <br />00 <br />..u <br />~8. <br /> <br />24b M <br />'RONOUNCfD DfAO{Ho.,) <br /> <br />1'0. <br />PRONOUNCED DU,D <br />(Mo.. DOl. Y,..) <br />24<. <br />0.. ......... .. ._....Ii. o,.d/<< ........tiM. i" .,. .pi_. ...... _Clilffe4 et <br />.... Ii... ~ _d p". ..wI d... .. .. C......:I ....... <br /> <br />25 Dr. Wm. J. Landis. M.D. <br />RIOtS,.... <br /> <br />Nebraska 68801 <br />DAlE RrCllVID IY RIOISTIAI (Mo,. Ca,. Y,.) <br /> <br />26b, <br /> <br />t.",,"1 ............. ....4.... <br /> <br />~c./ <br /> <br />~_...._... <br /> <br /> <br />10_- __. <br /> <br />WAI CAsa. HfllItD TO-.oM:Al <br />DAMlNt. oe c~ \ <br />-... -.. .. No., f\o.J 0 <br />29. <br /> <br />300. <br />l...nMY AI _OM <br />,...." '" -...., <br /> <br />".., 01: . '.D. .... <br /> <br />C,,, 01 tOWN "All <br /> <br />\ <br /> <br />" <br /> <br />'''',1.,1,/ e 'f ~ <br />R~CORDERS MEMO: WA~fIt7/ J - "7~ <br />t. All b-f r alK S"o /~..; ~ <br />.fie .' <br /> <br />STATE Of AEBIASrA <br />HALL aJlMfY <br /> <br />I ~RfIW CfmFY THAT THE MOUE IS A PHOTO-COW Of THE ORIGINAL ~ATH CERTIfICATE <br />FILEII WITH THE BUREAU Of VITAL sTAnsncs. ." <br /> <br /><" <br /> <br />,,-.' <br /> <br />//7 .__----:.~. <br />~l~ii,"d..:~~'<..v:J <br />(/ .,.. , <br /> <br />---.... <br /> <br />." <br /> <br />SfeSCRlBfll , SItIOIN TO BEfOflf ME THIS //I~ flAY Of <br />----......... <br />.IUDI1M A.IVDIOU. <br />.,........,. - <br /> <br />)tJ!. ~e.,-u.-cW <br /> <br />19 .i.1.. <br /> <br /> <br />9-'" ... ~ '1# a, -(;"U..f!AdAb <br />Arlr.tw PlIU T (t <br /> <br />L <br /> <br />-.J <br /> <br />L <br /> <br /> <br /> <br />,...,---.... <br /> <br />, <br />i:,. <br /> <br />