|
� � STATE OF NEBRASKA ,� ��
<br />, � � �,
<br />� �ty ,,, A �,; � "� � .��:;� � .
<br />WHEIV THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT q��HF,AL�W1/#JVA�f�IM $�RVICES, IT CERTIFIES
<br />THE BELOW TO BE A TRUE COPY OF �"HE ORIGINA! RECORD ON FILE WTTH TH� N�i�SKA �D�A`iQRTMPJ�T O'F, HEALTH AND
<br />HUMAN SERVICE5, Y17"AL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITpRY �`O,IR "I�l,�'At�',��� �5 �+�, . ,�
<br />� �',.,� ,;
<br />> �•.,
<br />DATE OF ISSUANCE , f p
<br />. , i � �
<br />°"� �' �,�"F�L1E�'vr,c,CQAI��'1� �� ,, ,,� �.
<br />OZ/09/2012 ' A, � � �45S�5�A�Nfi. ST'q��!;��GY5'�'RAR
<br />_�� �,L7,GP�U�T,I�EJVi;CC��',��AL.ITIl�r4NC�
<br />LINCOLIV, flIEBRASKA r � ��({i�'�t�,S.F,RIl� y ��' .
<br />�0120�44�� ��R r,��., �,,� ,�
<br />,; � r$e. >
<br />, ' ���,�` y '
<br />. � � .. ... .. . � � _ � �.�� r r.,�
<br />
|