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<br />WHEN THA4COPYCAR SES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
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<br />DATEOFISSUANCE pry 1 -VA
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<br />Rev. Richard WallacMale
<br />15, 2003
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<br />7 Years ws
<br />„ A
<br />�.
<br />Minister '_ Church Ministr
<br />_
<br />FATHER NAME FIRST MnrnE FAST 17
<br />MCI 'CRT MIDDLE ..IN FICA.,
<br />William Ra and Hovis Sr.
<br />Clara Anna Wieland
<br />IX WAS OFn
<br />- INFORMANT NAME
<br />EYED IN T PPMEA Fo:U la
<br />C. AIER
<br />Y. .N.
<br />I IS Y., . .11 IM F.
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<br />- - - - -- Viola Hovis
<br />INFOPMnM EI ACTRESS ISTAECT OR N FO .NO- Cm OProWN: STATE 3Ml
<br />319 W. 13th Street, Grand Island Nebraska 68801 _
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<br />DEC9a PE P �X A� -- _
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