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<br />WHEN THIS COPY CARRIES THE RAISED SEAT. OF THE NEBRASKA STATE
<br />DEPARNENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPT
<br />OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF_HE -AL H
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORX.FOR'
<br />VITAL RECORDS. -
<br />DATE OF ISSUANCE 40� 41
<br />JUL 2 9 STANLEY S. COOPER, DIK$CTOfi.
<br />LINCOLN, NEBRASKA BUREAU OF VITAL ST4T;SrlI S.
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<br />Henry Ral h Schriciccz • .
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