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85- 004176
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />OF AN ORIGINAL'RECORD ON FILE WITH THE STATE DEPARTMENT OF;HEALTH:
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY-FOR
<br />VITAL RECORDS.
<br />DATE OF ISSUANCE
<br />,04,4,/
<br />AUG 2 2 WS STANLEY S. COdPER, DIRECTOR
<br />LINCOLN, NEBRASKA BUREAU OF VITAL'STATIST1d
<br />With reference to:
<br />SE4SE4 , 3 -9 -10, Hall STATE OF 1091111ASIM- SPARTUM OF NEA TH
<br />County, Nebraska. SUMMW VITAL STATISM$ 84 03212
<br />CERTIFICATE OF DEATH ,;
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<br />Hazel Alberta Smith Female
<br />March 8, 1984
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<br />] pban, Nebraska ♦ U.S.A.
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<br />Dept of De ense
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<br />n�*siand Memorial Hosp.
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<br />Inpatient
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<br />braska n► Hall ,% Grand Island ,s, 800 Stoeger Dr. ;� �`es «w'
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<br />William Glenn Smith 17 Elsie -- Marsh _
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<br />H1 No ,•Helen Smith - Sister - Doniphan, Nebraska 68832
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<br />Ma rch 12, 1984
<br />m. burial sn m,. Cedar View Cemeter )oniphan, Nebraska
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