OEPARTMEMT OF PUBLIC MEAL - OFFICE OF VITAL RECORDS 'MASSA AA !MI DA. STANCLA•0 CSIIT/INCATI, 9•31Thno-4") lt} ?MC OA AT SURTO IF OTNLM THAN CCRTIFICR Inn OA NOM 100 Champaign,Illinois 61820 I, DENNIS R. BING, duly elected, qualified and acting County Clerk of Champaign County, Illinois, • and keep