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<br /> r WHEN THIS COPY CARRIES TSL RAISID SEAT. OF THE NEBRASKA SFATE �QO�Q���O ' �
<br /> 1 DEPAR'fI�NT OF HEALTB, IT ,CERTIFIES 2HE BELOW TO BE A ,���CQ$.Y.•.,.
<br /> . OF AN�ORZGINAI. RECORD ON FILE. W�li THE 3TATE DEPAR��''OF�HF�liL'Ti� � � - -
<br /> . BUREAti �F VITAL, STATISTICS, WHICH IS THE LEGAL DEPi�S�T08Y FOR� �'-.`�.' ,
<br /> VITAL RECOR]?S. � � � . - . .
<br /> DATE OF ISSO CE .(f;� ,, - .
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<br /> t��'`� � STANLEY S. CQOP�Ti; •D�Z(SR. -
<br /> LENCQLN, .NEBRASKA BIIREAU OF VITAL S�TiCS �
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<br /> OHI�AUOiVtTALSTAT157iCS ` � . _ . .. - .
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<br /> � Rrdan � Maro Ke�i�` Male ` ��Eebruary 13, ig9fl - ' �:.
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