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WHEN THIS COPY CARRI'KS TRY RAISED SEAL OF TH.. NEBRASKA STATE <br />DEPARTMENT OF HEALTH, IT CEF'71FIES THE BELOW To, BE A TRUE -UPY <br />- WITfi THE '3 <br />OF AN ORIGINAL XEC00 ON FILI, . . STATE DEPARTMENT OF HFALIH 85 .00439 <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEf,AL DEPOSITORY FOR <br />VITAL RECORDS. <br />DATE OF ISSUANCE 'AdA�el *4-- <br />STANIXY S. COOPER, DIRECTOR <br />LINCOLN, NEBRASKA BUREAU OF VITAL SMISTICS <br />STATE OF REOMKA - KPAR i MINI Of HEALTH <br />$MAU of VITAL STATISTICS <br />CERTIFICATE OF DEATH <br />'r'-Aif cif MT. I— <br />Alta FAn& Aarvey - Fems1v Febru&ry <br />.1 IiN�-ffl I DAW f•;.Tl OF <br />- Ta, .414.10 <br />C7 f 76 <br />Nsbrask& • U.S.A. Married hwu— Harvey <br />wM <br />Rouse Own Home 4 Hail <br />YGIS L. iranais Yedical Cqnt-sr�,. L-1 -it <br />_patio. <br />U, I -C I - it-if zcwwv <br />Nobraeka A411 jrA.-A ifilarld 3020 W.N. Front Str. Yw <br />1w <br />(doe) Charles Usin (doe) Anna cmdal <br />- D.fvg <br />NO w Hc-xv Hw-w*y-Huxb&;4-��)2U W.U. Front qtr. Orand island <br />-,UW`'$' 04 Lvt�1.30- Nf-9 -7;1 -LIM 117--"-,- 17';-1 <br />,Ix 5 Mwood Cemetery U4 -cit. kault Nebms ka <br />f "aacbsen Funeral ksi 411 "00 Str. St Pata. Nob.-acos la <br />0 t1rua ry 7. Yvo*-, <br />IZV 'Z" 7w..46 p45 ""r— k .defy <br />4t <br />c OwswuW1 0 <br />U <br />I <br />