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<br />5W ~ 35-/c1-;? 88- 102802
<br />Aloe J;; J/[J .5 - 9' - 9
<br />/v,.c:17ft~1 WHEN THIS COpy CARRIES THE RAISED SEAL OF THE NEBRASKA STATE
<br />f\~ DEPARTMENT OF HEALTH, IT CERTIFIES THE BELOW TO BE A TRUE COPY
<br />'crL1>'4 ' OF AN ORIGINAL RECORD ON FILE WITH THE STATE DEPARTMENT OF, HE1\LTH
<br />BUREAU OF VITAL STATISTICS, WHICH IS THE LEGAL DEPOSITORY.FOR/
<br />VITAL RECORDS .',:
<br />
<br />I
<br />
<br />DATE OF ISSUANCE
<br />
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<br />\ " .' -~'i'!!~_"":'"
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<br />STANLEY s. COOPE&.'Ql:R:E.~OR
<br />. >. "'~ ,'f'" '~~ :<.:'~'''~'..''"1,~;'\~' ..,.
<br />BUREAU OP VITAL/a~I\T'a:STICS
<br />. " ::I~.~.:(~"~;:..:""
<br />
<br />MAY 1 9 1988
<br />LINCOLN, NEBRASKA
<br />
<br />pgs..""CVS) REV. 4-57 ..
<br />DlI:PARTMENT or PUBLIC HEALTH.
<br />EDUCATION AND WZLrAJUr:
<br />BmTII NO. 128........
<br />,. ~ .. ....nt
<br />., fl:lY
<br />
<br />STATZ OF NEBRASKA
<br />DEPAltTMENT OF HEALTH
<br />Bareaa of Vital Stat.lsUea
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