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<br />OFCEASEO--NAME rNL aroa.r uir SEX IDA1E Oi DEATH ~ NONSn, on ~, ie ~~ i -_-~- - ~-
<br />John Pokorney, Sr , Male ~, June 3, 193
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<br />fATNfR--NAM[ rns .Dar uss ,MOTHER-MAIDf•[ WANE rinr +~DDSe u s
<br />~ Katherine Krehaul
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<br />CFRTEFIEf- AA+f ! N~a+' i SIGNATURE see s r,rs ~DAT iE NED iWNrn, •,,, • ;
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<br />:E. H. C. Anderson M•D. ',,, ~._L-Le7-aC~LlG ivr ~ ~-nr ~«liC~~>7_~
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<br />DATE „orvrn rUNFRAI HOME NAME AND ADDRESS • s r o +o e•r. U r.r:.
<br />T_w J~,e 7~ ?Q7~_ ,: - s Il W.I~ceni Grand lsland Ne. b8801
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<br />~ERXDAIMER SIGNAtURE 6 LFCENSP~~N/O~ - l~~y
<br />?56~,).I v ~/ . ~ A.f A',.s~- n rF .fC~E i/v f~o,,FE~+ IGt/A, Ec15ERAE
<br />REGIS.RAR--SIGNATU f `/~ ,c/.,. J/ ~•
<br />IM T:~/:; /^f ~li('~J~~/ ,+t 2 /y/U'6~1 U~ J .~ /`~
<br />WHEN `f.S~S COPY CARRIES THE RAISED SEAL OF THE NEBRASKA
<br />-'"STATE DEPXkTMENT OF HEALTH, iT CERTIFIES THE ABOVE TO BE
<br />A TRUE CQPY OF AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />~BEPA,RTIiENT OF HEALTH, BUREAU OF VITAL STATISTICS, WHICH
<br />rT:r_bT DEPOSITORY FOR VITAL RECORDS.
<br />aS„ THE !+•.......
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<br />DIRECTOR OF VITAL STATISTICS AND _ASSISTANT_STAT_ E REGISTRAR
<br />LINCOLN, NEBR.4Su4 Issued April 23, 1981
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