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<br />88- 107022
<br />
<br />WIlEN TillS COPY CARRIES TilE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES TIlE BELOW.TO B.~ ~ ~RVE COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEtAR~MERT'OF HEALTH
<br />BUREAU OF VITAL S'IATISTIrs, WlIICH IS THE LEG,,~,,'IlEP.OSITQki'1:0R,
<br />VITAL RECORf;. . ... , . ' "'-"
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<br />DEe 2 11988 STANLEY.',s,~/@~f~.~~riECTOR
<br />LINCOLN, NEBRASKA BllllEAU OF~Y:11*,' '~'fATISTICS
<br />Lot Thirty-Seven (371 Ande~son Secord S\lbdi~i~ion
<br />SU'rE OF'NElIlASIlA-OEPARTMENT 0 lInL"T
<br />BUREAU Of VITAL STATISTICS 87 0 7031
<br />CERTIFICATE OF OEATH
<br />
<br />DATE OF ISSUANCE
<br />
<br />Amended A\l~ust 17. 1 QS7
<br />DlCIDIN' HAMI ..ISf
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<br />NMN Sussex
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<br />1109 S. Eu ene, Grand Island, Ne.
<br />lOCAtiON tin alTOWN S'ATE
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<br />21. ston-Sondermann 505 West Koenig, Grand
<br />DAn! Of U. H (Me., ,. ,.' Z ~ DA IGNID (Mo. Do,. "'.' HOUI O' DEA'H
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<br />.0: CATE 51 NfDIMo_. Do,.. 'f<.) Ji= "'OHOUHCEDDUD "ONOU"'CfDD~AD(HDllt'
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<br />2.0. R. Cronk, M.D., 908 North 68803
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<br />JUN 16 IBB7
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