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1 <br /> " Form R-328. 2m-2-59-924805 <br /> t <br /> t4 <br /> a (LSE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) <br /> Condition AGE <br /> DATE OF FULL NAME OF DECEASED I I I DISEASE OR CAUSE OF DEATH <br /> R'hether sin <br /> a = NUMBER ATH (If a married or divorced woman or a widow give also SEX COLOR } C%- owed, <br /> (primary and immediate catue <br /> maiden name and name of husband.) E ( divorced Years Months Days <br /> ' <br /> 14, <br /> 1y- �4 t ��4tL-Z • �. _ _ <br /> „ <br /> rt , <br /> hi <br /> i <br /> � f <br /> OR <br /> 7� <br /> Cdr , <br /> aA <br /> I <br /> WJr- <br /> AN14i <br /> _ <br /> in <br /> r <br /> 3� <br /> ---. _ -. <br /> i Ali <br /> i <br /> r <br /> { <br /> i <br /> ' s a <br />