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<br />STATE O� NEBRASKA � O�: � Q�,.�►� �
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH AND •
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGIMA'L `RL��`'OR���bN 'R
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, I�irAE �R�7(�DS.� ����,.
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. � t�_ •.. 4,� ��,
<br />ISSUANCE � � ��� �,
<br />DATE OF S'tAF\f��Y 0�3P�R � °
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<br />Frances Alice Roesler Femalc Nov.� 10 1992
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<br />1�19 So.l'�Oth, #104, Lincoin, NE68546
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