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<br /> '° � DBPART![ENT OP HLALTH� IT CERTIFIES THE BELOW TO BE A TRUE CQPY
<br /> ' � •� OF AN ORI(iINAL aECORD ON FILE WITH TNE STATE DEPAitTMENT OF HEAIIfFi
<br /> � �,' � BUREAU OF VITAL STATISTICS, WHICN IS THB LF,(ii/U. DEPOSITORY FOA "
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<br /> - , .. - DATE OF ISSUANCB �-�. - � ,,.,-.'�-
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<br /> . '�. ,�-� �EP �J � STANLEY S., COOPER� AIRECTOA --
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<br /> ''•-" CENTIFICATE OF DBATN
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<br /> r:� Lloyd Charlea Green Male Auguet 21. 1990 - -
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<br /> ��� • w ��� � Clear Creek. Nebraska �4 ' October 13. 1915
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<br /> " . Nebraska Hall Grand Island 1421 E. Sth 68801 Yes �:`�.3'�-'"'--
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<br />- • White American n� MarriQd Eva I. Reynolds --
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<br /> Owner/ erator 01'� Sanitatian 9th Grade ' ��'�=''-"='o"'�`-
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<br /> • NO -------- Eva Green. 1421 E. Sth. Grand Island. Ne. 68801 --�_::`_�,�.,�;�,.
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<br /> ..,,�, 8 Au . 24. 1990 Westlawn Memoriel Park Grand Island, Nebraska •���;��.—--_-
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