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<br />~TATf OF NEBRASKA - DEPARTMENT OF HEALTH
<br />IlUREAU OF VITAL STATISTICS
<br />CERTIFICATE OF DEATH
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<br />83-004193
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<br />- ~CfDfNT_HAMf R;;;R! JOHN ~IfE :.lXMALE r~~~~;r;~,Do'i;;9
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<br />ADDU" Of cWDiHWtiUiCUH:COit:'Piii'l: I'~UIN 01' (:<:,iut:iiri"fiOiN"tv) ,i;;;;'~;;;;f
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<br />Hellbusch, M.D., Noorolc>&,l.ca1~'=-IL.....!.E~.L~.2}_~<?s.~!]i....A1dg.. Omaha. Nl
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<br />~.:'::'Wlltart..IS COPY CURIES THE RAISEO'SEAL
<br />/f, ,S;rATE-l1XPUTMENT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />"; ~. . A TllUE: COPY OF AN ORlGINAL RECORD ON flU WITH THE STATE
<br />'..~ ...:' J}JPAB.~JNT or HEALTH, BUREAU OF V lfAL STATIStICS, WHICH
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<br />nIUCToll OF VITAL STAl'ISTICS M1l ASSISTANT STATE REGISTRAR
<br />! .....{'...'1 NEBllASlA 1<.<"'''' '~f'ptem.ber 24, ).21.2.-...,
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