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<br />STATE OF NEBRASKA
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<br />4
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<br />WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEAL TH AND HUMAN SERVICES, VITALRECORDS
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS, . .... ,~"" '~:~'I'.. "It \,(..LL. . .......;, '. u
<br />
<br />DATE OF ISSUANCE . ,'"' l:J/~i~
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<br />2 0 0 8 0 5 5 4 8 , ':'i ~~~ ~~oit;'~bis~~AR
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<br />,; .'(iEPARTMENT,OF HEAtTHANO
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<br />STA11! OF ~ - DEPAImIINT OF MUf....i:; .:> ;.,
<br />BUlllAU 0fI VITAL STATIITICS "; ~.; I : "';Z-3
<br />CERTIFICATE OFDEATHi.. -*~<v$'''' ,?'~":': hol,...6S
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<br />~V'-.';1J., -i99S
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<br />JUN 0 42008
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<br />LINCOLN, NEBRASKA
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<br />Wood River Nebraska 68883
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<br />Grand Island Nebraska 68801
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<br />D. R. Colan, M.D., 729 N. Custer, Grand Island.
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<br />Nebrasy 68803
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