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<br />STATE OF NEBRASKA
<br />WHEN THIS COPY CARRIES TH� R,4ISEp SEAL OF THE NEBRASKA DEPARTMEIVT OF W�ALTH AND
<br />HUMAN SERVICES, IT CERTIFIES THE BEL�W TO BE A TRUE COPY OF THE ORIGIII%kA.t R�CORD ON
<br />FILE WI7`H 7'HE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN S�RVECE�, Ifll'r"�1$s�,"I'�1Rf�,,,S
<br />pFFIC� WNICH IS ThIE LEGAL DEPpSITORY FpR VITAL RECORDS. . �;"w� �j��; {;+ ���+ �
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