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STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES TME RA.iSED SEAL pF THE NEBRASKA DEPARTMENT pF HEALTH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRUE COPY OF TME ORIGIl1jA(�. Fi�,EpRD ON
<br />FILE WI1 H THE NEBR45KA DEPARTMENT OF HEALTH AND HUMAN SERVICES, VI7`Al RECORDS .
<br />pFFICE, WHICH ZS THE LECCAL DEP0577`ORY FOR VITAL RECORDS. '� ;�"..� .'
<br />DATE OF ISSUANCE �
<br />$TANLEY OE3R�'6t
<br />ASS���ANTw�TA.rE REC�I5TR,4R'
<br />10/6/2 010 � Q i O O���� DEPAR�ME�FT (7� h1E,4L
<br />LINCOLN, NEBRASKA HIJMAIV•,SEf2VICE'" " '
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<br />6Q1 N. Webb Ruad Grand Island, Ne. 68$0 3-4Q5D
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