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WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TR C OPT,
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEk ;OF-R,
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE, LEGAL DEPOSITORY FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE o
<br />OCT 20M STANLEY S.'tOOPER, DI TOR
<br />LINCOLN, NEBRASKA BUREAU OF VI1a ,,� �I
<br />fat 1 lac Cji (Jest V 6e,,J Add 10622
<br />STATE OF N£HRAWA -DEPAM WENT OF HEALTH
<br />bamm of Vital MESliaEieD
<br />CERTIFICATE OF DEATH
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