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<br />� STATE OF NEBRASKA �
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<br />WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKR DEPAR7M�`l�f'T;(��' �E�4 MN �
<br />HUMAN SERVICES, IT CERTIFIES THE BE�OW TO BE A TRUE COPY OF TH� O�TIVAL F�'E�D p"�N '
<br />FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SER-1lICt`�,, L��AL�"�E ��. ��
<br />OFfTCF, WHICH IS THE LEGAL DEPOSI7'ORY FOR VITAL RECORDS. �, , r�j y 4'' `' ,�� ;�r ,,
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