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<br /> a'�-. .� rW�H�N TH S� aOPY� CARRIES THE RAISED SEAL OF THE NEBRASKA
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<br /> < -, i��S TyE 1?f',,,?A Z2f+ENT OF HEALTH, IT CERTIFIES THE ABOVE TO BE
<br /> i �R�IIgy��'� O,�Fj�AN ORIGINAL RECORD ON FILE WITH THE STATE
<br /> t�K O�F',`HEAI:TFi, BUREAU OF VITAL STATISTICS, WHICH
<br /> I,5%,�'rFi�."?�G�� DEPOSITORY FOR VITAL RECORDS.
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<br /> DIRECTOR OF VITAL STATISTICS AND ASSISTANT STATE REGISTRAR
<br /> LINCOLN,.NEBRASKA' Issued November 30, 1976
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