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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 DEPARTgE~T~P~ HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL .DEt'OSi.:IQi(y,.,FOR
<br />VITAL RECORDS. . ,:> .">c',.c>,
<br />
<br />88-101086 ~:' {. '."l:P~'~\.. .........'.'._
<br />DATE OF ISSUANCE . 4 ' . ',. .
<br />.' '. ,_~~ '''''' I. ..
<br />MAR 1 1988 STAN~F)Y,.S~ C:P.~PER~~DI:REcTOR
<br />LINC?~ ~EBRA~~ / (/:'. BUREAU,.o~7~!A~CSfATisTICS
<br />J{ECORDE~S MEMO;~ ~~. . <JJ1J~ i:/:~:t/;r ~/
<br />-. Reg. at Deeds
<br />STATE OF NEBRASKA-DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS 87 0 94 97
<br />CERTIFICATE OF DEATH
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<br />DECEDENT HAMf
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<br />MIODl(
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<br />LAST
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<br />I Kenne th Dale
<br />lAC! (e-Sl-. Whit.. 110(.. A....tKon OIfGIN/OfSCfNT(e_Sl..Ualion.Me.icon_
<br />'ftalfl" .fIe.) (Spef:ify, GorMOi'I. efle )($PMi(yJ
<br />. WhIte ,
<br />CI\-Y AND STAn 0' IIITH (II no' .ft US...
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<br />IINSIOf (lTY LIMITS
<br />7 th f ~~:.(Yes or HoI
<br />MIDDLE LA ,
<br />Burch 1,7 Lena Hoods
<br />IINfORMAHi-HAJt.j-.If1AHQ...NSHIP-Il\AJUHG ADO_ESS CSJltftO"'O NO (ITYOITOWN S'A'l 1"1
<br />I WIFE: Helen tlurch
<br />1'9 1003 W. 7th, Grnnd Island. Nebraska 68801
<br />:CEMEUIY 01 CIEMATOIY - NA.Mf I LOCATION CITY 01 TOWN STATE
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<br />10. Grand Island Cit Cemete 10.1 Grand Island, Nebraska
<br />I fUN~~!OOTf:ER~~Hrs ~ "ftbm: ~'rr~~N, ".". ""
<br />III 1123 West 2nd St. Grand Island Nebraska 68801
<br />i,.. DAn NED (Mo Oa,. y" II HOUR Of DEATH
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<br />.! i ~ PtoNOUHCfD DEAD -! PRONOUNCED DEAD (Hou,J
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<br />1. A.K. Chakraborty,
<br />IEGISTUI
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<br />"A", Lincoln, Nebraska 68510
<br />DATE .ECEIVED IY IEGISTUI (~.. 00,. y,}
<br />AUG 1 1 1987
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