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<br />STATE OF NEBRASKA
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPAR~~N9EN~f O'F~NIL.IiL'Thl ~AAID
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF Th~E (3lRY~INA4' RECORD 0~!
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICE`S, ~ ~11~L fR~CQ~RpS• ' . 1 .
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS, _ ,
<br />DATE OF ISSUANCE ~ ~ ~ ~~!
<br />SEP p 1 2009 ~ O O 9 Q ~ 9 ~ ~. ' sra.Ni a~~a • .
<br />~ ': A"~•$ISTANT S~AT~ REGIS,T,RAI~
<br />D~PART~;I,EN7"OF F1~4LTF9 AND
<br />LINCOLN, NEBRASKA F=IUNf,~Fl~l S`~~lt'$~'~5,' ~• \ , ~ ,'"^ ,,
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<br />31R Bast 13th Street. Grand Wand Nebraskp 6811
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<br />Apfel-Butler-Geddes Funeral Hame ^ + [~ D~ !:read lslaad, Nebraska
<br />UNERAL NDAIE ADDRESS I5TRGET OR R.F.. AIp CITY DR TpNel STATE, 41P1 '
<br />T 1123 West S~ond Grand !eland, Nebraska, b5501-5894
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