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WHEN THIS COPY CARRIES THE RAISE)) SEAL OF THE NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO B9,-A TRUE COPY <br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE ^bFfAlkh45kT OF HEALTH <br />.BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL'IJ ...... <br />VITAL RECORDS. EPOSITORVFOR <br />DATE OF ISSUANCE <br />E 4ne <br />FB n r" <br />I_u 0 <br />STANI.V.S... C <br />LINCOLN, NEBRASKA PORER4,,,DIRECTOR <br />BUREAU `i CS AfiSTTCS - <br />0 (Pt 703 <br />STATE Of Nfl"S" DEPMMENT OF HEALTH <br />BUREAU OF VITAL STATISTICS <br />CERTICII%Arr <br />I - --- ur DEATH 7 Q <br />SOCEAt SKI <br />- --""--g UP: <br />13760 <br />ADUjISS <br />4"-t'ITM RID <br />OWK StATI, IR, <br />'�AL � � <br />JOWw <br />— --------- -- <br />Fran—.- <br />Vu I <br />•AS➢ 3t T"57 <br />=8 at CoQN14 04011A <br />78 utP occutato <br />M <br />toc.,wo, <br />7 <br />