� ' r STATE OF NEBRASfCA �
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAR�I�'� 3 ,��"�l �1l�Ia ^- _
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY C9� ��1� jyl�Cy��4�C01���°OIVI
<br />5.
<br />FILE WI'TH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN 9ERVIEf3�'VLT�La��l������6,�a t�,
<br />OFFICE, WHICH IS THE LEGAL DEpOSITORY FOR VITAL RE'CORDS ,'� .,� ``� •�.� d'`�:�;,'� ", +�;,
<br />�� �. r i � j di✓ ,� F . ^
<br />DATE OF ISSUANCE �� P �' r'`
<br />�"6� � � `a�'Tr�IFLP'Y �D,�R�R'� �'; y ;^� ; a
<br />6Y86� `�45��T1�I�T STA REGIS'7'R�112,�'
<br />LINCOLN, NEBRASKA � U � "' � O " � � ; '� :HLJM� �NT;��'N€A�TH �NDr;" : �
<br />�`� E �', y '
<br />7 ' � ,d n ���, e � ,�a;
<br />. �.
<br />�` . 1
<br />�� � - ��� ., = y � : p� �'�:� � 0� �7' � i� � �-
<br />t�l�ICd�s i� O�I►�N � ' „� � � . � .. � - , .
<br />�
<br />F�ob�c't ��r �aLivig t�e � �� �.�3- �' -
<br />.�. .�.� �r,.�
<br />O�a1'� .�!�a+ks ° �"f � o Ju1y i�. a925
<br />5�D5—�-$�42. -� � t� �w. � �a�wr�. e oa
<br />1 .� t� � t� �� Q �w IM+irli
<br />� 0�� � . . !�
<br />.1�� �'.�.@�' �i9&"�i"i. ° �t'r'�.� '�tl� �'� �t�1r7�M/ �8i��.
<br />� p �� s:i: : i+�
<br />N��A �,1�. ei �C'� ]G�1� y&�$.7 ��l �lC �i,�CC ]C�d �'
<br />� y �� � i �f�n ;�� ��`� �ar�� �a�e �'otartraocr
<br />� ��e� � �
<br />�i3��'�aidA��' �� ` � � � «
<br />��'� �ie�f Yr����.� ,�".
<br />�'
<br />i��11 i� �, a ' �llwi I�rka � . �or�
<br />�"�z�� £'��='�'� ,� � ��.� �. c���� �e�� sr�� �.� �� ' .,�;�°�
<br />� �
<br />�.e� a�e �0 1� � r.��.� ca�a�t c�� a,�i�n�; �.
<br />. �/� ° ' �
<br />���a�-�adclae 11?.3 W. 2r�. �� I�im�d, I�E.�80
<br />w�.�, � � , � ,�.,,
<br />�
<br />� � �
<br />� a..« N. �,
<br />e
<br />� e t�MOn Ya�el �ff �Y�A
<br />' W �O!'l0 �tIM'!!�W � � — �- - --- � -�... �.-.�.. ....... _o... . , .a..o-o..,..
<br />•�11mA�. Yo4 M�aa� �Ey, fR'W R . tM1'�i� A1E
<br />�[!/�' 1YM s df.q � �e�O, � �
<br />��- � �'� nwa. . r.� �w. rM
<br />��Z.� ��3
<br />� ,� �► � .,�� � �,� ���� .� � �.�, na �. ,�,,,
<br />�r����� � �-
<br />m
<br />�� +9. !Ni b� il aR �rqe, dr� 66�erw0 �i rw R�eo. dels an0 �ftmt i+�2 MM tl �s �� ws aNn d M� auf'a ��' WiMn� oownRl �t
<br />0� I�YI �j � 9�r t�Y. �lo Ang �! /w! 9a M�@ WY90}� �.
<br />l.L�V cl.� �. �+ g •
<br />�� 80� l5� �3 T(A 7!R 0&/tT1Q+ 366 MA80R�i�{9q llll€1b�NQ �7dpN 91EY�1 gDl�'1 � NtAd �?I1 �b
<br />CZ Y&'�i � O lil4p�e C1 Y� �1$ Q l�Ei �
<br />� Md1°B ;:4P3 9W . A ,I�Y O /@iq! � �°`•••
<br />.� � �� r� • !)72� N . �t� , ��� �gi� . � _ �_�
<br />
|