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202400411
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Last modified
1/29/2024 9:57:14 AM
Creation date
1/29/2024 9:57:13 AM
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202400411
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YWCP <br />Natt 1,0+ <br />STATE OF NEBRASKA <br />' O�yrggqaprv, e;,I9wL4AI@�ar gbnyli�`�� I9bGp4WIW@i�ege <br />THEN THIS CI:tPY CARRIES THE RAISED SEAL OF STATE OF NEBRASKA, IT CERTIFIES THE DOCUMENT BELOW fi <br />'SE A TRUE' CORY OF THE ORIGINAL RECORD ON FILE WITH'THE NEBRASKA DEPARTMENT OF HEALTH AND <br />HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS <br />DATE O IS&UAJ CE <br />12/1.8/2023 <br />,3042A &t4/1, <br />SARAH BOH:NENKAMP % <br />ASSISTANT STATE REGISTRAR <br />DEPARTMENT OF HEALTH <br />AND HUMAN SERVICES <br />20240041"1' <br />a�x�CA E OMATH 00 07 <br />a OA*t *A*, AAR <br />Arthur Stauss <br />amu'- <br />es [ 01121,17g8 — 02/23 58 <br />hw My!. �a, 0 lan � Nebraska adFIYC�JtaN�t�it <br />J ' 1 r; }`.'. St. Paul, Nebraska 688/3 <br />as. vot pliaroOGYpoM,' <br />�► r 1 ` T/� /037 ©wFUneC21.1. !lame alai* Star <br />❑'4""'• <br />wow No *ryaWx..br.Tr.7xg .. <br />3213 W. N r h "'runt <br />W.Caa <br />( O9 ire 4SItie <br />cadyvi <br />of Co <br />:::4411.'CMtlA <br />•Yq.atrY/7 wr.rr tettA A* <br />al OM a.. a., r., at al <br />..a. rr.rwa w.i 1140111 <br />rWitA.ctr[TMr T .10/10. <br />Oat r -L Ai n <br />Moa.aaatt <br />Y' <br />4atettl Waft <br />at CI M,0 <br />Joos 22, 2000 <br />W11r� <br />tat tatnu <br />/2,7/41 <br />0111111 0111111011111p <br />7p {MOM <br />aMVT aAttu 4o *AGMW <br />TwrvwTM <br />g'".1)5 r <br />a..ww <br />soague amok <br />0 <br />4, «w o a aasw+ehune w 0.M.02111. <br />Si,tki Copur Nm, X116 W. Ave., Grand Island, N E 68803 <br />a. tosit a0w 100** v1 <br />JUL 3 <br />•Rol1onm000rro IM.: M6 <br />o U. O.r.arM/rrrrwar.waMrt <br />• twttw.wawlrwawrrNratrrolir <br />iw.ab'AN. <br />. <br />W A01d711�rM ta1�WG Oortrlpl Mrl{M<0MM0 <br />wnrawamrm.Tyowu., ,?...w.. <br />ii. <br />
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