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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA HEAL TH ANQfflJ.~~N.cSERVICES
<br />SYSTEM, IT CERTIFIES THE BELOW TO BE A TRUE COpy OF THE ORIGIN~f)Y~ WITH
<br />THE NEBRASKA HEALTH AND HUMAN SERVICES SYSTEM, VITAL STATJ$tit'lS'::$Ef;tKiifj;wRifH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ?~i:';--"':=-'l/ld -\',
<br />
<br />DATE OF ISSUANCE ~e;;Jv~
<br />
<br />AUG 2 9 2006 20 0 6 0 8 4 28 ASl}fSTANT_STATE REqJSTFjAR
<br />LINCOLN, NEBRASKA HEAt'[H Af'P H~~~"'JER'f1FES
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