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ll" <br /> G5 <br /> S' <br /> Form R-328. 2m-2.59-924805 <br /> (USE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) <br /> -- AGE DISEASE OR CAUSE OF DEATH <br /> DATE OF FULL NAME OF DECEASED �vhnr�h sls n <br /> S ,� COLOR { gle,married. Years Months Days (Primary and immediate cause•) <br /> NUMBER DEATH (If a married or divorced woman or widow give also widowed,or <br /> maiden name and name of huahaad-S divorced <br /> r <br /> 30- _ _ _ � _��e1A . <br /> >� � _ tic. _�4 �� - �-_ ` _.. <br /> Ay <br /> d <br /> I <br /> i <br /> A, <br /> _ <br /> AC <br /> cF y <br /> i <br /> k <br /> iii ._..... ._._.-_._. ......... ......_..- -- <br /> j <br /> I � _ <br /> Al S, <br /> >t_ } <br />