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<br />BUNEAU OF VITAI. STATISTICS $ `~ ....~~ ~~ 1. 1_
<br />GERTtFIGATE Of DEATH „_ ,;
<br />DECLOlW~ N rF ~f(~St p10DlE ~~ DATL OE OEAINTMn., Del Y.J
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<br />1:~3EtiLL~T!(IS CtSkY CARRIES TAE RAISED SEAL. OF TAE NEBxASKA
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<br />A'T&9E CaPY-,;,6kF AN ODIG'IAAL RECS.&D ON- FILE LIITA TAE STATE
<br />DE~AFtTH&NTsU~ ?t$ALiF€, 8258EAU OF VITAL STATISTICS, WAICA
<br />iS TIiE,; L'~v11~ DEPnSiTORY FOsla~~VITAL RECORDS.
<br />iIiRECY'~7R OF iT7.F.L STATISS'ICS At3D A.SSISTAl~T" STATE REGISTRAR
<br />L.tiC~t.ti, :~B~A5t~? Issued "~ove~r 2b, 1981
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