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<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
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