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WHEN TMCopy CARRES THE RAISED SEAL OF THE NEBRASKA HEALTHAND' WAIERWCES
<br />SYSTEM, ITCER1AiESTHE BELOW TORE 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 WTAL RECORDS. /_
<br />/l/ 6' � -
<br />DATE OFISSUANCE '' ANLEY18A. COOPER "
<br />200204811 ASSISTANTSTATE REOsmn _.
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE OF NE9MSKM DEPMTMENf OF m orq AND AN smvacFS.FDIANC9 AND smYYr�oa'I
<br />cvT,IM AYCPnFTIFATH 01 06836
<br />_
<br />„c.pEx. NAME- Bernice MIDpLe Dobbs
<br />R_. ,RA x.m.rvl "sF acE.L.NaxneaY „NI,EP,rfnP
<br />. CNVFNORTATEOV bPTA " °79 mMDS MAY
<br />Wood River, Nebraska �_.
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<br />WHEN TMCopy CARRES THE RAISED SEAL OF THE NEBRASKA HEALTHAND' WAIERWCES
<br />SYSTEM, ITCER1AiESTHE BELOW TORE 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 WTAL RECORDS. /_
<br />/l/ 6' � -
<br />DATE OFISSUANCE '' ANLEY18A. COOPER "
<br />200204811 ASSISTANTSTATE REOsmn _.
<br />LINCOLN, NEBRASKA HEALTHAND HUMAN SERVICES SYSTEM
<br />STATE OF NE9MSKM DEPMTMENf OF m orq AND AN smvacFS.FDIANC9 AND smYYr�oa'I
<br />cvT,IM AYCPnFTIFATH 01 06836
<br />_
<br />„c.pEx. NAME- Bernice MIDpLe Dobbs
<br />R_. ,RA x.m.rvl "sF acE.L.NaxneaY „NI,EP,rfnP
<br />. CNVFNORTATEOV bPTA " °79 mMDS MAY
<br />Wood River, Nebraska �_.
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<br />9E. RESnENCE STATE 90 CWNTV
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<br />Nebraska Hall Wood River 302 East
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