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<br />r __ $l1E W1 MANTLE _ __ _ ___ ____ moral Rrt;islrar of Vital Stptistics [ot the
<br />~OgNTY _ RIO BLANC.O.
<br />(City, To'.vn, or CDUnty)
<br />State of Colorado, do hereUy certify that the above is a full, true, and corrrct copy o! Ule record of dceth o[
<br />_HAROLD EWIN AMICR _ _ _ -___ _ i„ ,,,1. custody, and aow on filr, in my office.
<br />(N;unc )
<br />7ivrn under my h:md and seal this ._.__ ~1_sT d,-ry o[ _ _DECEMB ER_ _ _ _ _ _ __ ____ ~B ~5
<br />SUE W. MANTLE BY: c~-~_. ~ ~_,ati~_,-a.~~ DEPUTY
<br />]ACaI lit {;iLtrar of Vital Slali~.ti1T
<br />Rr4istralion lli trio Ko. 194_ _ R 10 BLANCO _ Cutnlty, Colorado
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