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<br />I <br /> <br />I <br /> <br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEERASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE_A'TRQE COpy <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEf,~~*Y-'QF1,H.EALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEQ~!-> ,D~~$lTO.~,,[~~,R , <br /> <br /> <br />::::LO:~:::CE . ~'/l ~ . <br /> <br />DEe 9 1987 STAN~E:~~:~t::,.;~~~tE~J,::~~~EcTOR <br />LINCOLN, NEBRASKA BUREAU ;bF~.y;t~~.~''fk1'rsTIcs <br />. \ ; ~.~ ~ l ,: ~.\~.;\:~ . <br />, "87"07101 <br /> <br />Of <br /> <br />fI <br /> <br />STATE Of NEIIlASKA-DE'AIlTMEtIT Of HEAlTH <br />IUIlEAU Of VITAl STATISTICS 8 3 0 2 0 18 <br />CERTifiCATE Of DEATH!/J .)j 0 <br />Ml LA . OAT! Of OIATH /Mo.. Do" Y'.I <br /> <br />N - NAMI <br /> <br /> <br />Julian <br /> <br />IStll" 01....0. NO., (In 08 TOWN. StATI, ZIPJ <br /> <br />fel-Butler-Geddes 1123W. 2nd Grand ISland, Ne~8801 <br />DA N (Mo. '0 Yr.} " UI Of DEATH <br />.~t; <br />illA 1.... <br />..~s ~ PIONOUNC!OO!AO <br />I;e: i /Mo.. Oa,. Y,.I <br />u!:z 2. <br />JAB 0............-...... .....}.. iA-'iee..... I_ '"' ..,lId_..... .1((_".4.. <br />~ 8 U .... ti... ... __ pa.. .... .... .. ... c..-e4 ....... <br />u' '...'Ii...........4 ri...,.... <br />A"OINEY) a,pe Of P,i..., <br /> <br />14b. <br />PIONOUNCfD DIAD (Hau,) <br /> <br />Grand Island, Nebraska 68801 <br />OAT! 1K!1Y1.Y lEGIST"", a,/M... Oa,. Y'.I <br />-- j/':;/-' <br />2~ .~! -!'.A:-- :_~ ,~~ <I -/<:1.:) <br />It.....1 ~ __...4'" <br /> <br />Cd <br />p_ <br />H <br /> <br />ACe..... luectOl. HOMKIOI.. UNDIt. DATI Of fNJU" ,Me.. 0.,. 'fr.J <br />oe ...-.0 tNWUftOADON. ,."....,., <br />~ <br /> <br />_. <br />."",., ~ <br />,...iI,Y_- <br /> <br />stun c:it. ....D. ,... <br /> <br />Cln <>> tOWN Sf." <br /> <br />JOoo. <br /> <br />I, <br /> <br />L <br /> <br />L <br /> <br />L <br /> <br />STAT! <br /> <br />M <br /> <br />.,1 <br /> <br />I <br /> <br />~ <br /> <br />I <br /> <br /> <br />r^---------.... <br /> <br />wr <br />I; <br />~ <br />(. . <br /> <br />... <br /> <br />~. <br />