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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECgf!0J!tjJi'+~ WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATlSTlS~:i>t:~~liIJI!j',rf!J!CH!S . /
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. .111' ~.- ".'.'...<~'iJ;':~~;:/ =~~..II
<br />
<br />DATE OF ISSUANCE 200706 413 }JVf"'f!--tt;Am.EY~CfJO~i~'
<br />APR 0 3 2007 ASSIs,tA';/r s'rATE4:fEGI5tR!fIJ'{
<br />LINCOLN, NEBRASKA HEALTfit~ND.~U!t!~fJ=~:~KtfF/'
<br />
<br />STAlE Of NElaASKA. DEPAl11&lTQf.uw.m ANDHUUAN SElYlCf.S mii~,~~~. . ,,(,.
<br />vrrALSTAnsncs --~.:':"~ ." 0" .. ....:
<br />CERTIFICATE OF DEATH . ~":..ft+~5 0 7 9
<br />l""Of7roi.:tt-. ~ 1 FIRS'" ~[bAST : 3 Q.ti 'OF ,Dt:'~Tlof If.,.'......,::'tAl-)'..,
<br />Hilda Mule Cu.berOll ' April 19. 1..
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<br />to At SIOEN(;l; ... STA T~
<br />Nebraska
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<br />Island, NE 68803
<br />I J2I) OA TE FilED Bv REGIST....R !lIIl>. "'" " I
<br />MAY 11 2004
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