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<br />STATE OF NEBRASKA
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<br />WHEN THIS < COPY CARRIES THE RAISED SEAL OF THE STATE OF NEBRASKA, IT
<br />CERTIFIES THE DOCUMENT BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD
<br />ON FILE WITH THE NEBRASKA DEPARTMENT C HEALTH AND HUMAN SERVICES, VITAL
<br />RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS
<br />r,
<br />DATE OF ISSUANCE
<br />07/14/2017
<br />•LINCOLN, NEBRASKA
<br />202306029
<br />STANLEY S. C+ •PER
<br />ASSISTANT STATE REGISTRAR
<br />DEPARTMENT HEALTH AND
<br />HUMAN SERVICES
<br />STATE 0. NEBRASKA- DEPARTNIENTOF H EALTHAND KAMAN SERVICES FINANCE SUPPflg�
<br />CERTIFICATE OF QEATH U C l a '.
<br />I. DECEDENT'S4 *MP (sirs,.
<br />,,,di.. - `SiINx} 2.9E% J.DATE OFOGl1'hl Bk. Den Y.):.
<br />_ _ _ Lillian R. Amick 1Female May 7, 2009
<br />4. CITY AND sum ORTiRPITORy,ORFORE13'ICOVNTRYOF31PTH 6a,W4.!.7.aclEp.lda�Y 30.W1'{DER1yLan I 59.UNDE_R1DAY 8. DATE OFSIRTN(IND,D#R.'io
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