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Form R-328. 2m-2-59-924805 <br /> (USE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) <br /> FULL NAME OF DECEASED Condition AGE DISEASE OR CAUSE OF DEATH <br /> DATE OF p Whether sin <br /> - <br /> FULL <br /> SEA f COLOR gl marred, <br /> NUMBER (If a married or divorced woman or a widow give also widowed,or years Months Days (Primary and immediate cause.) <br /> jDEATH maiden came and name of hns6ard S , $ divorced-71 _ <br /> 1 <br /> 1pj <br /> t <br /> ------ - <br /> l"1 V <br /> /t <br /> vJ J <br /> i <br /> GAJ 4$ I}_ <br /> 2 — — <br /> 7 <br /> 41 . <br /> s � <br /> N � <br /> fA <br /> i' <br /> 5� <br /> -----_------_- <br /> t <br /> t i <br /> f <br /> �{ t <br /> f . <br /> } <br /> i1� 944 <br /> 7 � <br /> h� <br /> C <br />