|
<br />88- 102821
<br />WHEN' THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH. IT CERTIFIES THE BELOW TO BF.AfR;~..~.:..COPY,
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTKBn.'OJ"HIW-TH
<br />BUREAU OF VITAL STATISTICS. WHICH IS THE LEGAL DEPO,sitQij:;:F,O~;/<
<br />VITAL RECORDS '.' "':.';/0\.. ~J.A~}; .
<br />. . ;/.... ,..,<;;:';:.\.i:;p".;~,
<br />J.I6...~ ., .'.IA '..~'i. ::~. :.....:: .... ".l'. ..:;:.."l\'...;:.)t..::.:...';'.:'
<br />DATE OF ISSUANCE ~MIUfY ,,'" . e.:' f,,;~,':l~hf
<br />APR 2 8 1988 STANLEY 'S~:';'~~,~!,~;)"t~.OR
<br />BUREAU OP'~i~~:~tt':i.~:rICS
<br />
<br />_..:,;,~'~i):~!~(':" '
<br />
<br />I
<br />
<br />LINCOLN. NEBRASKA
<br />
<br />STATE OF NEIIIASU-DlPARTME'U Of HULTH
<br />IUIftAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
<br />
<br />
<br />Of 10fN' - ",....,
<br />
<br />f.ItS'
<br />
<br />--"--"101)1'-
<br />
<br />M
<br />
<br />....~ .:..-:-=-::t:.....:-::.-:..:.::..-. 4Iec* ........ ..
<br />
<br />,.. ,l~.....,,....- riM.'"
<br />.NITIIf,~ .. '.....1
<br />
<br />,'" Pulmonary insufficiency
<br />OUt YO. 01 u,. CONSIOUtNCt 01,
<br />
<br />III Chronic obstructive pulmonary disease
<br />,,""" .... M1.w.c:_Y ~1ICIN6 - c_ .--. ..-,,- .... ... ,01."" :::J~~~Ji r..~~ ;:tMat f.=~.. .. ...,
<br />II
<br />Cor Pulmonale ,.. 0 He {J H No
<br />lOtc.DeM1.. __. I, 0&11 O/IIMJ.... ,.... 0." f, I OIKMI _ INjun occ_
<br />011 _ lMYISflGAr_ ,,-,,,.
<br />.., )lW,
<br />-.... At _ ".11 01 ., II. ...
<br />,'-"'" '." He,
<br />
<br />. years
<br />, Ia-' _ _...........
<br />
<br />;years
<br />.... (AN *._D 10 "DoC.'
<br />r.-.a oa CCMOHIa
<br />:~." Y.. .. ~ No
<br />
<br />
<br />
<br />(1ft Oll row.. Ir....
<br />
<br />L
<br />
<br />~
<br />
|