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. <br />WHEN raza corr caaRzco THE RAzsoo SEAL or THE uaauAnuA szuTs <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRU*,CQPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMIfftT 6F-YsALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOS124i.'FOR�' <br />VITAL RECORDS. <br />DATE OF ISSUANCE <br />BUREAU OF VITAL STATISTICS <br />RECORDERS MEMO: <br />DUKAII Of %qTAL STATISTICS <br />� <br />� <br />� ~----'-----' DEATH _ <br />Michael Francis Koziol Male November 17, <br />American February 8, 1921 <br />e Is <br />a no arianne Sock <br />0924g;MI34 Hall <br />F"'r'a n'c is Medical Centerjj� Emergency Room.._ <br />Grand Island Yes 1" <br />Hall Grand Island i,,, 2023 W. 12th es-- <br />Nebraska <br />Joseph NMN Koziol -it <br />Josephine N.— Torczon <br />12-2-45 .Marianne Koziol (Wife) 2023 W. 12th, Grand Island,Ne. <br />��imf AND -Doafss 68801 <br />sf <br />` nu� <br />` <br />' e' <br />110V 18 M6 <br />� | <br />' <br />` <br />- <br />` <br />' <br />. ^ <br />| A— <br />AS A CO* <br />to, of <br />| <br />