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<br />102105
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<br />WHEN THIS COpy CARIj.IES 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.
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<br />DATE OF ISSUANCE
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<br />STANLEY S. COOPER, DIRECTOR
<br />BUREAU OF VITAL STATISTICS
<br />
<br />JUN 1 0 1987
<br />LINCOLN, NEBRASKA
<br />
<br />DfCEDENf NAME
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<br />'IISI
<br />
<br />STAU OF IUBUSKA-DEPAItTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH L . '-~__~;0
<br />~DOlE lA1 UX DAn 0. OEAIH 1_.. Oor. Y<./
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<br />ISD. Hebrulca
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<br />16. (deo) Robert Christian ctu-istensen 11 CJ.moa .
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