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<br />I <br /> <br />,-- OfCEOEN1- NAME <br /> <br />STATE OF NEBRASKA- OEPARTMENT OF HEALTH <br />BUREAU OF VITAl STATISTICS <br />83- 0011';;'8 CERTIFICATE OF DEATH! ".' <br /> <br />78 <br /> <br />115116 <br /> <br /> <br />fiRST <br /> <br />MtODU <br /> <br />"'Sf <br /> <br />I <br /> <br />..b <br />~ESIDEN(:f-Sf...tE <br />.... NeiuUu.Iz.a. <br />A H.E- _NAME <br /> <br />G.IWJld ! 4-land . Ne.bJta.6Iz.a. <br /> <br />68801 <br /> <br />:'.01< M <br />I PRONOUNCED DEADfH'Hlr} <br /> <br />1...."-'.._ __ .ad d_. <br /> <br />1""",-,,',,-,,,- _...~ <br /> <br />ACClOUf1, lVtC10l. ~OOl. UHOif _ ,DArt Of t"'hlll' f_.. D",~_ ~, I <br />eM: nMD!HG tNitt!.nGAllQt<ol is,-J,-, , <br /> <br />, aUlorSl" <br />j,S_""',....r.;."j <br />l>lo i--' j 11 /VD <br />, Of5.CtiM HOw 'l'ollut'l' OCCUltfO <br /> <br />! ';"'$ CAU lUEtttD 10 MICICA.t <br />. u.uw-llfl 01 t:OIlOMtt <br />GS;-ofr l''':/j;)' ) <br /> <br />300, <br />.A tNJliaT.AT"""OI:l <br />:1 -lS~,......Noi <br />I.. 300, <br /> <br />; lOb . J<.\r: <br />I ~.l :'I~":-:'; ;;:=;; --. ...-. l"~ <br />i JOf. <br /> <br />M lOd <br />to(A.TlON <br /> <br />SfUUo.t.O lo4o <br /> <br />CITY oa TOW", STA" <br /> <br />JOg <br /> <br />WHE&titS~;(f01Y CARRIES THE RAISED SEAL OF THE NEBRASKA <br />S~~':~PAJT~E~ OF HEALTH, IT CERTIFIES THE ABOVE TO BE <br />A>l~u,tC~~' AN ORIGINAL RECORD ON FILE WITH THE STATE <br />DE~~~ENTOt~BALTH, BUREAU OF VITAL STATISTICS, WHICH <br />~S~HE LEGAL'~EPOSt:ORY FOR \ITAL RECORDS. <br />, '\. ~ "e.-. ,. :",,->,,-# I <br />...... . ".. .' " .'... ~.I ",0' <br />..,'<.."..'. GfA~~ <br />D~lt:,U~'I1~.STATISTICS AND ASSISTM'T STATE REGISTRAR <br />LINCOLN, ,~lI.ASKA Issued Februar:' 4, 1983 <br /> <br />~ <br /> <br />L <br /> <br />.-J <br /> <br />L <br />