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MEN lots COPY CARRIES THE RAISED SEAL OF THE NEBRASKA STATE 104461 <br />O <br />r DEPAMIMMT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY <br />OF M ORIGIN" RECORD ON FILE WITH THE STATE DEPARTMT OF HEALTH <br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY FOR <br />VITAL RECORDS. <br />DATE O?' ISSUMCE <br />4� <br />FE6 3 M STANLEY S. COOPER, DIRECTOR <br />LINMLK, NEBRASKA BUREAU OF VITAL STATISTICS - <br />NSls'a� fig ,� So�e� Lo <br />. STATE NR MtNUSIfA- �t►A�tT11lMT M TM "'�° c••-•R �' t/i• / /aft c� n 1 arc .� <br />M�OF"TAL 9TATq' M <br />i D Mme. <br />99 68105 <br />mi FES I1 <br />L <br />L <br />w <br />ell <br />F <br />