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STATE OF NEBRASKA
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<br />y WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DE,P�IRTMEN.�2��H AYTF�'XIIqD
<br />` HUMAN SERVICES, IT CERTIFIES THE BELOW TO BE A TRU�' COPY OF THE �� �.I���C�?l�f� �
<br />F�LE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVt�"S,� �2�ORDS'��, ��
<br />OFFICE, WHIGH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS "` `e .• ����' �;,. t�� ``�.
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<br />DATE OF ISSUANCE ' `� �"� + .. �' �,.. . : .✓,��� ti
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