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<br />i-mE!., THIS COPY CARRI..:.S THE i<AE=:D SEI\L OF THE NEBRASKA ST;\TE
<br />DfPAR'l'MENT Of HEALTH, I'i' CERTIfies THe BELO;"; TO. :;;tA~RUf; COpy
<br />oi" AN ORIGINAL RECORD ON FILE Wi. TH THE STATF.?EPARTHEWl'::'pF l!C,\LT!:,
<br />BUREAU Of VITAL STATISTICS, WhICH IS THE LEGAL ~EPOSITORY~fOR
<br />VITAL RECORDS, .,./ "
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<br />5Tl\NLEY. S. cO,OPE;R: ,>:DIRr:CTOR
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<br />BUREAC OF V!l'.r..{STA'rrSTICS
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<br />DATE Cf ISSUANCE
<br />
<br />NOV
<br />
<br />7 1984
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<br />LIN~OLN, NEB~~SKA
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<br />BIRTH NO. 126...,....
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<br />STATE OF NEBRASKA
<br />DEPAJtTMDl"T OF ii5ALm
<br />&Ulcau of Vital staUstks
<br />CERTIFICATE OF DEATH
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<br />67 01908
<br />STATE nLJ: 110.__..............__..,._._,..._.._..
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<br />PKS-7WfVS} ftE'V'". "":;7 v
<br />DEPARTMENT or PUBLIC HEALTH.
<br />EDUCATION AND WELFARE
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