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<br /> W1iEN THIS COPY CARSIES T�IE RAISr."D SEAL OF THE NEBRASKA STA�B � .
<br /> DEPARTMEr3T OF HEALTH� IT CERTIFIES THE BELOW TO BF A Te1tJ� �UPY
<br /> r OF AN ORIGINAL RECORD ON FILE WITii THE STATE DEPARTM�'� OF-ii��.'EI `�
<br /> � BUREAU OF VITAI. STATISTICS, WHICH IS THE LEGAL DY8(3SIT0$Y F0� ' . . �
<br /> � VITAL RECORDS. - i -. �
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<br /> DATE OF ISSUANCE ,;. ��".I, .
<br /> �EB I � STANLEY S. COOBEA,, DIRA,,G�QR
<br /> • LINCOLN, NEBRASKA B[JREAII QF VI'�AL�_3Y!'�16'�YCS
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<br /> OKEOEMT-NIMf �16ST MIOGIE , WTt q DEA N(M�,Qa�,��)
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