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<br />--nie:N6-itheast Quarter (NEl/4) of Section Seventeen (17), Township Eleven (11) North,
<br />Range Eleven (11) West of the 6th P.M., Hall County, Nebraska.
<br />
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND _HUMAN SERVICES
<br />SYSTEM, IT CERnFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL ~oRttiiiif9LE WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATlmcSSECTION;oliiHlcH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ~.' ... ~o_" :~~ ~"J-ft~.=~~_.'-.-.c.-.:.~".
<br />
<br />DATE OF ISSUANCE - -- - .. , fl. ~~
<br />NOV 2 2 2005 A~S;STANr:::;:J~=~
<br />LINCOLN, NEBRASKA 2 0 0 5118 4 5 HEALTH ANl}/H~N $ERVlCE~_~~~M
<br />
<br />STAD OF NBIJIWKA.. DEl'ARTMBN'tOFfUWm.umHUNAN SllRVa$.~AM.;.t,~
<br />CER'J=tA~~EATH --, '-~:~''""04919
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<br />Lylle
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<br />Arthur Rainfortb
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<br />.June 20 1_
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<br />Nebraska
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<br />80. OOUNlY OF DUo tH
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<br />Grand Island
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<br />CBfRUT OR R F,O. NO.. CllY OR TOWN. STATE. 111'I
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<br />820 N. Burwick Rd 68883 I v.. 0 . tie f!C
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<br />~3808 S l30tb Rd Wood River NE. 68883
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