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Form R-323. 2m-259-924805 <br /> > -��� ofd <br /> (USE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) <br /> Condition AGE <br /> 'ther sin- <br /> FULL NAME OF DECEASED DISEASE OR CAUSE OF DEATH <br /> gle <br /> NUMBER <br /> DATE OF (If a married or divorced woman or a widow,give also SEX COLOR married, <br /> DEATH maiden name and name of husbandL) wi owed,or Years Months Days (Primary and immediate cause.) <br /> divorced <br /> f <br /> -------- -------- <br /> ,4 <br /> __6_p7- <br /> 4: <br /> ------------ <br /> 0/' <br /> 'q <br /> 93' <br /> --- -------- <br /> _7 <br /> 01-a -1 1(- <br /> Al <br /> 11,C <br /> t.. ( � 1� � / �� �.`�-1 l�� l-��C6/a+ 1r4�^-'V11„ � __ --.__— •% �� .. ._.. ..___._.. _.......��.`. -._.._._..��`/�J �� 1. <br /> uf <br />