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<br />
<br />"WHEN THIS Copy CARRIES THE RAISED SEAL OF THE NEBRASKA HEALTH AND HUMAN SERVICES
<br />SYSTEM, "CERTIFIES THE BELOW TO BE A TRUE COPY OF THE ORIGINAL _~Q-Qf! FILE WITH
<br />THE NEBRASKA HEAL TH AND HUMAN SERVICES SYSTEM, VITAL STATJmCS SliCBON.oWHICH IS
<br />THE LEGAL DEPOSITORY FOR VITAL RECORDS. ~,.,.,.,..'.'F.-..'-:"-.~~~:~_C-~"~i f;ra.-~~.~
<br />
<br />DA TE OF ISSUANCE r ."-.' - pf= .'- -.- .-.--
<br />DEe 3 0 2003 2 0 0 5 0 9 4 81~~STiNJ:G=~:
<br />LINCOLN, NEBRASKA HEAL THAf(o.-INMAN~RfAf2~_i!tStEM
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<br />STATEOFNEBllA$J(A.Dm"ARTMENT...... OF.... HEAl.:.' ...:tHAW.' .'m.1MAiN. _. ....._.....~......_.. ...._._:_~....:iNa....~.~_.....;iUI}..~_.-s~
<br />VlfALSTATIST1CS -,c. ,~"- ,-"" --<.-- U '"
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<br />... Grand Island, Nebraska
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<br />Larry Burmood
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<br />Larry Burmood
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<br />Grace Grand Island, Nebraska 68803
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<br />Livingston-Sondermann F.H.
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<br />601 North Webb Road
<br />in I_OlAT€ CAuse
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<br />Westlawn Memorial Park
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<br />Grand Island. Nebraska
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<br />Grand Island, Nebraska 68803
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<br />: y"" _ "" ;< ~y~. 1m _______________
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<br />;1fIl; DATE. CFlItNW (iIW. t:\rqo"(,-/ M<; lIOUfl OF l/<J(I''''
<br />
<br />~ 5" XDecember 22,2003
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<br />2003
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