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STATE OF NEBRASKA �
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTN Al'VD HUMAN SERVICES, IT CERTIFIES
<br />THE BELOW TO BE A TRUE COPY OF THE ORIGINAl. RECORD ON FILE WITH THE NEBRASKA DEPART ,M�NT_ OF HEALTH AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL_ REEdR[jS� "`p .� ,,
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<br />DATE OF ISSUANCE /�/���� �'i ��� k
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<br />04/11/2012 A55.�5�`,4tvT S�'AT�R��'S`TRy4R .:,; `, °, . ; . . .
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