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'. au HOV. 4. 19 6 n Yiv in'mto -:� do �ar 'n G l l I: en v- O r n d 1 1 .1 1 6` ..6 8 . ...--.:: t�z.'i`}_=, <br /> � 1(i20 �eenn.._ �e...roe � <br /> ^ IYWUA[�-SIONAIV!lllltlNffNO /� ]n•�. t L� ��� <br /> �- c-c.. -� �'ku.�c:,�,. ,,. j�,l�`1����at�i /�1��/,�1�/Gl�b/ , ' ,: ° <br /> .t ; <br /> � '�a r..- <br /> � - WHHN THIS COPY CARRIES THE RAISED SEAL OF THE NEHRASKA � �' - <br /> e ` �- - � STATE DEPARTMENT OF HEALiH, IT CERTIFIES THE ABOVE TO EE <br /> - -« A TRUB COPY OP AN ORIClNAL R2CORD ON FILE WITH THB STAYE � �` <br /> -DBPARTMENT OF HEALTH, BUREAU OF VITAL STATISTICS� WHICH • �, - . <br /> . ��� � IS TA& LECAL DEPOSITORY FOR VITAL RECORDS. � <br /> ., . � �! � � - -- <br /> ' DIRECTOR QF VITAL STATISTICS AHD ASSISTANT STATE RECISTRAR <br /> _ LIHCOLN, NEBRASICA _Issued November 16, 1976 <br /> .r <br /> . •L ,� ' <br /> z _ 1 � <br />