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85= 001874
<br />STATE OF NEBRASKA - DEPARTMENT OF HEALTH
<br />BUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH ,
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<br />NTY NUMSER uSVAI OCCU►Ai,ON (G 1d N .f KIND Of BUSINESS ON INDUSTRY COUNTY Of DEATH
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<br />FATHER-
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<br />H -"AM N F MIDDE U —�
<br />Donald
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<br />Joan Stone
<br />tFIAS OlCeASEO EVEl IN U. S. AMEND#*Kest
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<br />ITLeRo Johnson -hus., 3207 WI? 17th. St.
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<br />May 28#
<br />CEMETERT ON CRfM,1Tow_ -NAME _
<br />10CATIO011 C"YCWTOWN STATE
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<br />1982.
<br />WestlaWn Memo. Park
<br />2D.. Grand Island Nebr.
<br />RAI NOM! -NAME AND ISwETDNIf.;W •••�fYAMIWffiyff, Nebr.
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<br />D►T DEATH (AI• -, D.,, Y•.)
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<br />AND ADDR[SS CERT,r If�llHr
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<br />Joseph J. Roil, N.D. UnivSrsity of Nebraska Med. Center 42ndand Dewey Ave.
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<br />WHEN, :HIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />STATE DEPARTMENT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A.TRUE COPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
<br />"Af6A"ws' WE V-rxAL STATISTICS AND ASSISTANT STATE REGISTRAR -
<br />�)f � Issued June 11, 1982
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