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<br /> WHBN TEiIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA �
<br /> 51ATk llEYAIiTDt�NT OF HEAI.TH, IT CERTIFIES THE ABUV�: `l'0 BE -� � :
<br /> A TRU� COPY OF AN ORIGINAL RECORD ON FILE 'dITH THE STATE � . ,
<br /> D�PARTAIENT OF H�ALT2I, BIIREAU OF VITAL STATISTIGS� WHICK I
<br /> IS THL� LEGAL DL�POSITORY FOR VITAL RECORDS. � ,
<br /> .� �/t.p� _ �.t.�.e.a
<br /> UIR�CTUR OF VITAL S'fATISTICS AND ASSISTANT STATH REGI5T1tAR ;
<br /> . LINCOLN, NGBRASKA Issued Septembcr 28, 1977 .
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