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200405690
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<br />3203 W. State St., Grand Island, Nebraska 68803
<br />,,Jerom E Janulewicz, Hall County
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<br />,,Jerom E Janulewicz, Hall County
<br />117 E 1st Grand
<br />Island. NE 6880.
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<br />FOR VITAL STATISTICS USE ONLY
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<br />I i�I,�y ce ?i`y this to be a true ;nd rorrect c0dy of the nfigWdl
<br />filed , 'evlthl the Slate 01 Nehraska
<br />sly -- -- .by —-
<br />Slgned day0���
<br />Notary Public
<br />TMV
<br />..Census Tract No
<br />e TERRY L LOSCHEN
<br />'` "` MYCO%4fIISSION EXPIRES
<br />l „; r 'F May 2, 20DB
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