Laserfiche WebLink
1 <br /> Form&-328. 2m-2-59-924805 <br /> (USE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) � <br /> Condition AGE DISEASE OR CAUSE OF DEATH <br /> 1 FULL NAME OF DECEASED I <br /> DATE OF Whether sin- <br /> NUMBER (If a aw ed or divorced woman or a widow,gimme also SEX COLOR gli married, (Primary an i ediate cause.) <br /> DEATH ma;den name and name of husband-) �dioorC °i Years Months Days c Lw <br /> -- ----------- <br /> Aw <br /> A .l -- C <br /> 614�' '6 <br /> 3 6f <br /> a � <br /> Aw,�_7,3 <br /> Yr <br /> 1 <br /> r <br /> I <br /> i <br /> ( �6 <br /> SI <br /> s <br /> r <br /> n <br /> /g <br /> 1 <br /> j tw r <br /> 7 <br /> S <br /> 1 _— <br /> M <br /> t <br /> f <br /> _._.-__. ___ <br /> A i <br /> r ;$ <br /> \w <br /> t <br /> M <br /> t i <br /> it <br /> 1 <br /> 5. <br /> 1 <br /> k <br /> t <br />