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Rf615fRAR.-fKNAfUfF O� �1'O�1 IOCA�tfO�HtA� .�-.-.�--- <br /> � �sb ,�• , . #193 ,,, � �N _ <br /> ` ,-( .�,<<. ,'�����: . . ���y��� . �a,/y�7 � ., .�: <br /> . , � . ;- . . .- <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 . <br /> � <br /> � <br /> ; <br /> .tA <br /> 1 <br /> � <br /> f' 1S <br /> 1 <br /> 1 • <br /> ���� . _ _ _..__. .._"_"_.__. ___'" __"_. _ <br />