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<br />DA TE OF ISSUANCE
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH AND HUMAN SERVICES
<br />SYSTEM, "CERnFIES THE BELOW TO BE A TRUE COpy OF THE ORIGINAL RECGRQ.:DN.FIt::E WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STA TlSTIC$4i8..~--!IY#JCH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. -='~?:~:~ "J,..=c~~~.
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<br />LINCOLN, NEBRASKA
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<br />200512066
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<br />I Robert Carlton
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<br />; MAR 1 7 2003
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<br />LOT TEN IN BLOCK ONE IN ISLAND ACRES TWO IN Tf:E CITY OF U;'J\ND
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<br />1ST ,AND, HALL COUNTY, NEBRASKA.
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