|
<br /><Xl
<br />C'I:)
<br />~
<br />C'~
<br />o
<br />.,....
<br />
<br />,
<br />00
<br />00
<br />
<br />~""';'-:"""':':~~'-'::_~;""""='~==~",:,.:.::.i-~;" ':""'~.~.__."'_""__"
<br />
<br />Ir;i"-~ '
<br />:, (J\J i
<br />~", _-::~/ /
<br />/: "r:
<br />
<br />.-
<br />
<br />
<br />,,"'OIl_IN
<br />.._ttn ..
<br />IIlllilSTlUC1ION
<br />MMWAl.
<br />
<br />Pklce......___
<br />
<br />PolSC..__...............
<br />
<br />Work..._.._...__...__
<br />
<br />uc...:...._.._...._....
<br />
<br />Reject.._............. ,.
<br />
<br />A..._,....._._.:........ .
<br />
<br />s....._.................."
<br />
<br />>-
<br />~ c...........................
<br />
<br />...-...........................
<br />
<br />...
<br />'"
<br />;:) ............................,
<br />
<br />lit .................................
<br />u
<br />~...................,.........
<br />'"
<br />
<br />~ 0,....................., ,..
<br />...
<br />II' ..........,..................
<br />.J
<br />< ...... .....................
<br />...
<br />:; ..... ......................'
<br />
<br /><< ... ................,.....,..
<br />
<br />f2 [..........................,
<br />
<br />Part II
<br />
<br />TMV,.............._..,.
<br />
<br />CenS\l~ T.oet No,
<br />
<br />~--,~~-~-~-~~.---;....- _."'"'._.--'~~~.~-'_'"-_.-"'-'--__,'__
<br />
<br />". .~. . j. ;:.
<br />1 ~::~\ G
<br />',. 1\ ~
<br />
<br />L
<br />
<br />STATE OF NElRASIlA-DEPARTMENT Df HEAlTM
<br />BUREAU Of VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />
<br />OlCtDINT - N<IM(
<br />
<br />Itar
<br />
<br />."1)0\1
<br />
<br />LAS
<br />
<br />DEArM ,... , 0.., r, I
<br />
<br />4
<br />
<br />InDati~nt
<br />IN$IOI CITY 111'''$
<br />Up.rllf.hl .' H.J
<br />ISo les
<br />u. -
<br />
<br />11"11' O. I' D NO tIn o. roc:es'O'i 1"1
<br />
<br />W. North Front G.I.. NE.
<br />l'OC..rION CITY Ol rOWN StArl
<br />
<br />70d Grand Island Nebraska
<br />,,,",, 0." Q NO c.n 01 TO".., "..., ''', 68801
<br />
<br />..
<br />
<br />... H \n '\) Y'\,a.l,\...P_"~ \,,"\, Q
<br />-11(;.1'.... '
<br />
<br />'1>c.'i ~ ~
<br />
<br />1'610
<br />
<br />t.,.,...1 .......... .... .-4 ......
<br />
<br />........& ,...._ .... .M .....
<br />
<br />~
<br />DUI TO. 01 AI .. COHItOUINCI OJ,
<br />
<br />
<br />~ ....,.. f ......... --' .... ....
<br />
<br />..
<br />
<br />"..' 011' D ...
<br />
<br />em 01 'OWN ,"U,f'
<br />
<br />',"",".;;.''::~ :-,~:>i:"":,,_'.:....,;. ..,-_....>,.,__,...' '_.'.
<br />
|