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<br />WHEN THIS COpy C~~IES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF'HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE C9PY
<br />OF A..~ 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 />88- 101944
<br />
<br />DATE OF ISSUANCE
<br />
<br />~j~
<br />STANLEY S. COOPER, DIRECrOR
<br />BUREAU OF VITAL STATISTICS
<br />
<br />MAR 2 8 1988
<br />LINCOLN, NEBRASKA
<br />
<br />r DECEDENI - NAME
<br />Geor
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<br />~:.. . '!: STATE Of NEBRASKA->DEPARTMENT Of HEALTH
<br />. . .. 'BUREAU Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH I
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<br />ill~I
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<br />MIDDt"E
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<br />LA~I
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<br />T, j
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<br />1906
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<br />..lDLHE
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<br />I.L GrallJ tsland I NE
<br />I(~IOIN(I - ~tAII 'COUNty
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<br />"0 Nebraska I'b
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<br />Hall
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<br />I ST.UT "NO NUMlfl
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<br />John
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<br />w..~ DI([A~fD IVII IN U 1 ..IMID '01C111
<br />
<br />John Pedersen
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<br />i lOCAIION City O. TOWN 11..1E
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<br />ZOo Burial 10b March 19,198~2o. Grand Island City
<br />(M',,\.MII -SiG....I'E '-JEHU "0. i JUNItAI "O"'l - NAME ....0 AODtf5S
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<br />:'''1( Q' DE,..'" / '. Do" y, ,,"" " 2:~ 0....11 ~IGNED fMo 00', y" INOU. OJ DEAl"
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<br />IC'''N 01 COUNll' ATlOINEYt (l,P. ., p"ft'/
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<br />nDavid R~ Colan
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