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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE" ODU909
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE _A TRUE-COPY
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTNJWT4 ,QF,HEALTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL SFyPpSITOR�f°4it;•.
<br />r VITAL RECORDS.
<br />DATE OF ISSUANCE Y
<br />FEES , 7 1985 ~1.
<br />STANLEI Ai 'G DIR OR
<br />LINCOLN, NEBRASKA ,
<br />BUREAU 17`gB ICS
<br />STATE OF NEIRUKA- MARyMM W MEAITM
<br />OF VRAt STATISTICS 8 4 12932
<br />CERTIFICATE OF DEATH —
<br />Lloyd
<br />Y Edward Jacoby Male November 13. 1984
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<br />White American ArOL
<br />A ..r,.a. w. N rr►u spec. 27, 1915
<br />Gr a'd Island, Nebraska ., U.S.A. M10OM"o0AO1Keors,«;til r �"'- •°+»»ru
<br />fawns ustl.t CWAT,W1fGAV6A/.e/«e/1M , Married „Ellen M. Chew
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<br />Henry --- Jacob Elizabeth
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