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<br />WHEIV'iilts::cOi,>.y CARRIES THE RAISED SEAL OF THE NEBRASKA
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<br />AlRUE'--CoP.Y ot. AN ORIGINAL RECORD ON FILE WITH THE STATE
<br />D~AR;TKENT',.iiF'l in::ALTH. BUREAU OF VITAL STATISTICS, WHICH
<br />IS'"7HE LEGAL, D.E'pOSITORY FOR VITAL RECORDS.
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<br />DIRECTOR'Or'VITAL STATISTICS AND ASSISTANT REGIST~~R
<br />LINCOLN, NEBRASKA _______Issued July 7, 1976
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