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STATE OF NEBRASKA—D£PARTMENT OF HEALTEf
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<br />CERTIFICATE OF DEATH. f_ j, 76 J 4
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<br />, ANNA KATHRYN OBmLCL m '12 Female I March 31, 1976
<br />RaDE -Att. MHO. .r..K." .wMN. AG[._uN uMN I •eu — I aI DATE Of PMTH ,.owrn, o COUNTY Of DEATH
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<br />ENN NO. rRAR- SJGNA /UM • IO "ClIVER ■r t"A, NarsnA■
<br />WHEN.`fdiR DOPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEP OF HEALTAm,IT'CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />OF ORIGINAL REC00 ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />BURET#, Oil VITAL ST,A,T.TSTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL ORDDJS /.
<br />-- • -f`C:. Issued Jah- 28, 1985
<br />DIRECTOR, BuizAtj OF VITAL STATISTICS LI OLN, NEBRASKA
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<br />� _ _ N. Kelso Camet Farwell (rural) Nebraska
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<br />:Yac°obESen""unsra Ho "pau'1 E j.e"br. OfJO�
<br />ENN NO. rRAR- SJGNA /UM • IO "ClIVER ■r t"A, NarsnA■
<br />WHEN.`fdiR DOPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEP OF HEALTAm,IT'CERTIFIES THE ABOVE TO BE A TRUE COPY
<br />OF ORIGINAL REC00 ON FILE WITH THE STATE DEPARTMENT OF HEALTH,
<br />BURET#, Oil VITAL ST,A,T.TSTICS, WHICH IS THE LEGAL DEPOSITORY FOR
<br />VITAL ORDDJS /.
<br />-- • -f`C:. Issued Jah- 28, 1985
<br />DIRECTOR, BuizAtj OF VITAL STATISTICS LI OLN, NEBRASKA
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