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<br />WHERE xapa �HLRIES THE RAISED SEAL OF THE NEBRASKA
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<br />ASilb._OFY" QP 1�N.RIGINAL RECORD ON FILE WITH THE STATE
<br />DE *49i $NT OF� RBI�I� H BUREAU OF VITAL STATISTICS, WHICH
<br />I�,TRH 'LEGAL DkiOS TORY FOR VITAL RECORDS.
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<br />DIRECTOR NI �rSTATISTICS AND ASSISTANT STATE REGISTRAR
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<br />STATE OF NEIAASSA- 904WMINT OF HEALTH
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<br />November 3, 19821— 1:25 a. M it ul.,D..,T''
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<br />ACCtRENT, SUK/0E. NO«CME. 4/My. DATE OF «Nm fw•.. Oy. r. 1 HOUR Or INWET 0lKSR[ NOW g O f occ" EO
<br />OR PENNING, INMINIATION j1p. /)
<br />.�. ]a 701. M 70I.
<br />Af Mw"- M IIW, /«N, +Ir••1, 1•{I•I,, {DCAigN STNS? of* P.o W. CMOs row" STATE
<br />w—mb. 1w w N•1 •Ili.• ►rile,.,.... !S•wi/,/
<br />I.I.n•1 MwN. www w :A1M
<br />WHERE xapa �HLRIES THE RAISED SEAL OF THE NEBRASKA
<br />SY,ki,11 1iAR , d HEALTH, IT CERTIFIES THE ABOVE TO BE'
<br />ASilb._OFY" QP 1�N.RIGINAL RECORD ON FILE WITH THE STATE
<br />DE *49i $NT OF� RBI�I� H BUREAU OF VITAL STATISTICS, WHICH
<br />I�,TRH 'LEGAL DkiOS TORY FOR VITAL RECORDS.
<br />< ' r
<br />DIRECTOR NI �rSTATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, i6RA KA Issued November 15, 1982
<br />b .
<br />I.I.n•1 MwN. www w :A1M
<br />WHERE xapa �HLRIES THE RAISED SEAL OF THE NEBRASKA
<br />SY,ki,11 1iAR , d HEALTH, IT CERTIFIES THE ABOVE TO BE'
<br />ASilb._OFY" QP 1�N.RIGINAL RECORD ON FILE WITH THE STATE
<br />DE *49i $NT OF� RBI�I� H BUREAU OF VITAL STATISTICS, WHICH
<br />I�,TRH 'LEGAL DkiOS TORY FOR VITAL RECORDS.
<br />< ' r
<br />DIRECTOR NI �rSTATISTICS AND ASSISTANT STATE REGISTRAR
<br />LINCOLN, i6RA KA Issued November 15, 1982
<br />b .
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