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<br />Lt ,ts 3 & 4, Block 6, 4th Addition to the Town of Cairo" :Hall County,
<br />Nebraska. . ,;. .: ;.,,:,
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA' STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A :'TRU(C9P,'Y' 'I.
<br />OF AN ORIGINAL RECORD ON FILE WITB TBE STATE DEP~.~T ~9.~. ft~~' "
<br />BUREAU OF VITAL SrATISTICS, WHICH IS THE LEGAL DEfOSil'O,ay;,'f',OR( ',~",:,
<br />VITAL RECORDS. "''::::'"&''Y;;:<'~'~;'\:'':_'''
<br />
<br />88- oi0697ft jJl..j...~.!l~~a~TT0
<br />~ QA'lMHMY, ,~~.-
<br />STANLEY s.:p(j~~~~~~.~-:-
<br />BUREAU OF Vrr.ili~~st~s .
<br />.: ~"-~ ':. -
<br />
<br />DATE OF ISSUANCE
<br />
<br />DEe 1 9 1988
<br />
<br />LINCOLN,. NEBRASKA
<br />
<br />DlCIDI!N1'_NAMI
<br />
<br />""
<br />
<br />ST_IE Of NEIUSU-DfPMTllEIIT OF HEALTH
<br />BUREAU OF VITAL ST_nsTICS
<br />CERTIFICATE OF DEATH- 'l:(~'
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<br />I AND.I ATE Of IIITH,
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<br />50ClAl SICUllh HUMin
<br />
<br />'50. Nebraska
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<br />101. Ht Pleasan t Ceme te
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<br />22. A fel Funeral Home Wood River Nebraska 68883
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