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<br /> WHEN TIIIS COPY; CARRIGS TIiE RAISED SEAL OF THI•: NEIIRASKA
<br /> STATE DEPART:fENT OF HEALTH, IT CfiRTIFIES THE ABOVF. TO IIE
<br /> ;A ,TRUE COPY �F'AN ORIGINAL RECORD ON PILL WITIi T13E STATI:
<br /> ``AEPARTP1ErT'QF. HEALTH, BUREAU OF VITAL STATISTICS, WHICB
<br /> LS� THE LEGAL DEPOSITOFY POR VITAL RIiCDRDS.
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<br /> LINCOLN, NESRASKA Issued Novem6er 26, 1976
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