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<br /> � WIiEN T1iIS COPY CARRIES THE RAISED S�AI. OF THE N�BRASKA STATE �
<br /> DEPARTMENT OF HEALTH. IT CF.kTIFIES TH� BHLOW TO BE A TRUE COPY
<br /> OF AN ORICINAL RECORD ON T'LLU WITH THE STATE D@PARTMENT OF HEALTH � ,
<br /> ' BllREAU OF VITAL STATISTICS. WHICH IS THE LF•CAL AEPQSITORY FO�t � ,
<br /> VITAI. RBCORDS. �`f
<br /> DATE OF ISSUANCE � ��� ,
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<br /> F � 1 1� STANLEY S. COOPER� DIRECTOR , _
<br /> "" LINCOLN� NEBMSKA BUREAU OF VITAL STATISTICS > y
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