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<br />STATE OF NEBRASKA.
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT
<br />CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD
<br />ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />kf
<br />Sarah Boh,arkawlp
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT OF HEAVER
<br />AND HUMAN SERVICES
<br />DATE OF ISSUANCE
<br />1/5/2022
<br />LINCOLN, NEBRASKA
<br />20220043
<br />STAVE OIKI1A MM.i11
<br />OF VITAL LTAi JCS
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<br />Female March 27. 1990
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<br />505-72-3981
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<br />Jul,/ 17., 1933
<br />Nebraska Hail Wood River
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<br />John A. Wagoner Jr. ND 800 Alpha St.. Grand island. Nebraska 68802
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<br />���UTEnUnr�aHMR �rAA. pft)�C APR 51990
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