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Form R-323. 2m-2-59A24805 <br /> (USE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL..) <br /> Condition AGE <br /> FULL NAME OF DECEASED I DISEASE OR CAUSE OF DEATH <br /> DATE OF 'Vnether sin- <br /> !-4UMBER (If a married or divorced woman or a widow,give also SEX i COLOR married, <br /> tldo- Years Months Days (Primary and immediate cause.) <br /> DEATH maiden name and name of husband.) <br /> Z- <br /> c'-;400-r-f <br /> i � �(Q,e _ - - C� oda-�e_ ' !�_ � � /`�__ _C 7 � �_ Oka, fid,"- I <br /> ---------- <br /> ------------ <br />