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•--� , � STATE OF NEBRASKA 4 oti'ti`���
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA L7EPARTd�NT�'O'.F. N�I�TH AN�, ��,' �,
<br />HUMAtV SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF 1�H�"Ql�l'GI ����. ��� '
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERV,�E�,,f%Tf4L RECOI�S r� ,
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS, e; '� ' y °` � ,'; '�'+� ��
<br />. 9 � � \ `� � �1LY � Y'�
<br />DATE OF ISSUANCE f� �' � '�
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<br />AUG 31201� � O d. � Q! / 4� , A�S.f�'AN.�,S�TLk7 R STI�IR �
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