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STATE OF NEBRASKA �� � � +��� �� -"�'�,
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAl2TNi�'NT-t�F HF�N�Th; A/VD,
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGIIU,r��,yJ�E`G�OIRQ OAF ,�
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMA,N SERVICES,''I�,�AL�E4'Q.}2'DS.
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR V1TAL RECORDS. `'+ .�� ",` `� `- .`
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<br />DATE OF ISSUANCE • '
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