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WHEN MIS COpy CARWS THE RAISED SEAL Of ME NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES ME BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. / q '�"'O' I
<br />DATEOFISSUANCE q Tory^ANLEyS.COOPER-
<br />9/14/2004 200409735 ASSSTANTSTATEREGISTRAR,
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE DF NEBRASKA- OEPARI]ffiLi OP BNnANOHIIM.IN SE6VICfa FIIJANCE AlID BURbST r.
<br />VRAL ffI'ATYi1IC5 -_
<br />C:b0.11I'R.XIG VP LGnaaa : -. -.
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<br />O
<br />WHEN MIS COpy CARWS THE RAISED SEAL Of ME NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, IT CERTIFIES ME BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM VITAL STATISTICS SECTION, WHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. / q '�"'O' I
<br />DATEOFISSUANCE q Tory^ANLEyS.COOPER-
<br />9/14/2004 200409735 ASSSTANTSTATEREGISTRAR,
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE DF NEBRASKA- OEPARI]ffiLi OP BNnANOHIIM.IN SE6VICfa FIIJANCE AlID BURbST r.
<br />VRAL ffI'ATYi1IC5 -_
<br />1. 1. -- -
<br />❑^a^^' Auq 16, 2004 Grand Za�land
<br />na. cexETerroxa¢uxTUw,wTax ra Tax
<br />❑cx°"'°' ❑°°"'"' 3168 W. 8tolleV Park Rd. Gs'
<br />LOT EIGHTEEN (18), IN BLOCK ONE (1), OF ME VES FIRST ADDITION TO THE CITY
<br />OF GRAND ISLAND, HALL COUNTY, NEBRASKA
<br />C:b0.11I'R.XIG VP LGnaaa : -. -.
<br />Thomas
<br />Walter Care
<br />Male As TH 2004
<br />wTSOx9wTx rw,,, nr. vwn
<br />e**rzrc "•."°•°°°•ry
<br />s. .nE ,.xwm,.r uxoEn
<br />5°M09'
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<br />xw
<br />Ix "1
<br />Jul 29 1936
<br />Lincoln, Nebraska
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<br />❑ x.�:nw,.
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<br />640 MacArthur AV 68801 v ^❑X
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<br />Care _
<br />,e oECU9eo EV[x ix us.wEO.UrfES.
<br />axxx
<br />,w lx. x.. x%ue
<br />rc.��a1 www...wd..b.w.e . l
<br />02/03/1960
<br />as, 4u .lin.m.
<br />Carey_ _
<br />Ye 02(28/1956
<br />___ e<.o. xo_u,vw
<br />TwxaTATE.zv,
<br />1. 1. -- -
<br />❑^a^^' Auq 16, 2004 Grand Za�land
<br />na. cexETerroxa¢uxTUw,wTax ra Tax
<br />❑cx°"'°' ❑°°"'"' 3168 W. 8tolleV Park Rd. Gs'
<br />LOT EIGHTEEN (18), IN BLOCK ONE (1), OF ME VES FIRST ADDITION TO THE CITY
<br />OF GRAND ISLAND, HALL COUNTY, NEBRASKA
<br />
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