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<br />STAVE pF MEdkl4SSSA-OEPART'MEMT 9F 41EAlTN ~t
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<br />WAS DECEAS[D tVEB IN U.S. ARMlO PoKESf
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<br />3 DATt d DtATN (Ma., DaY, Y•.1 3~3 -IIONOUNCED D[AD iRONOUNCID DlADf(hrN)
<br />Augubt 25, 1979 i rAE.., Dai. Yr.) c
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<br />AN CERTIiI R IpNYSKlAN, C iNY LAN OR COON ATTORNEY! ( Ylra ar riMJ
<br />S. R, RATHBtlN, M.D., VA Medi,ca.e. Cen.te~c 2201 N. Bnoadwef.F. Grand ie~and NE 68801 ~
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<br />A (N [11 Y !CADS pER tfN! roe (p}, ( f, AND fell r.rar.d N.Ar.w aar+a./ Ma+ '
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<br />~a Progressive artariosclorotic brain disoasa yrs k
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<br />D NIO WNCY IN rNF rAST a rr.ra{Tlpf tT•aril, Tar ar E•N tNM1Rip q t
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<br />Urinary bladder irritation $ blaedi .„ c~ N. ~ No Sa,.+EY'a.«w) No ~~
<br />ACCIDEM, UTCIOE, NiYMCNX. VNDET., Gry d pUVNY (Ma, tMr. Yr) N01N Oi 1WYRY f3lMRMt VSftrRE OCCVRRBp - 4
<br />OR pENpMD NEWj110ATrpN. (Saatf,)
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<br />TErwtry Ti w EIaY !!AC! INItIRY _ M +waN. arh.,, IIXATIQti STRIFT !M 4t.R Na. tTYY Q AAfl F
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<br />3$i. ___.__. iSOR.
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA N
<br />STATE DEFARTMENT OF HEALTH, IT CERTIFIES THE ABOVE TO BH ~'
<br />A TRUE COPY OF AN ORIGINAi RECORD ON FILE WITH THE STATE
<br />DEPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS. WHICH
<br />IS THE LEGAL DEPOSITORY FOR VITAL RECORDS.
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