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<br />WHEN TH'1~"ft;'~'pf!cA.I\I\YES THE RAISED SEAL OF THE NEBRASKA
<br />STATE D2fARTMENT OF. ,HEALTH, IT CERTIFIES THE ABOVE TO BE
<br />A TRUE Ca~y~bf AiORtGINAL RECORD ON FILE WITH THE STATE
<br />DEPARTHEN:'f:r~_,H;:NI'RIi BUREAU OF VITAL STATISTICS, WHICH
<br />IS THE LEG~ii'-:J1~P~~~ORY FOR VITAL RECORDS.
<br />
<br />:.",' d;~#.d__ r:U~~.J
<br />DIRECTOR OF VITAL STATISTICS AND A!:SISTANT STATE REGISTRAR
<br />LINCOLN. NE8RASKA Issued February 28, 1975
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