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STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH A. ND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF THE OKIC~NXI~'~E~OftD Ofl~
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICE; V,IxA~, ~tF~CORDS ;
<br />OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. •' ~ c~ "
<br />DATE pF ISSUANCE ~r ,,~
<br />n +~ n ry STANCE OQPER ,
<br />S E P p~ 2 U 1 a ~ ~ r~ AS5ZS7"7'~ST,711"E REGISTRAR
<br />O O O ~ a7 ~ ~ DEPARTMENT ~F H,EALTt1 AND
<br />LINCOLN, NEBRASKA HUMAN-.S`~RV1~ES•., :`''.•'
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<br />~ Davfd H~artlett
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<br />131 n st~eria~r, Place 66843 ~. ~ ~•
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<br />^x ~ ^ ~.,. Jan. 24 20G2 Grand Island City
<br />qta CEMETERY Dp CREWTppY LOCAYgM Crtr OR 7pWS1
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