STATE OF NEBRASKA ,4` : ; ,
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTF� i4ND f'iU1M�V S�RVICES, IT CERTIFIES
<br />THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FIlE WITH THE NE'B. �,Q�f�i7��' AND
<br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR �I'�.. RECOR ��' � �'
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<br />DATE OF ISSUANCE
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