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7 <br /> Form R-323. 2m-2-59A24805 <br /> P <br /> (USE TWO LINES WHERE NECESSARY,ALL'_ AMES TO BE GIVEN IN FULL.) � <br /> t j Condition AGE <br /> 4 4 DATE OF FULL NAME OF DECEASED ! Whether sin <br /> DISEASE OR CAUSE OF DEATH <br /> NUMBER (If a married or divorced woman or a widow,sive also SEX i COLOR gf- married <br /> DEATH maiden name and name of husband) wa vow °r Years Months Days (primary and immediate cause.) <br /> _1 7 <br /> ed <br /> 3 60 02 �t�. �1 - �✓_ <br /> s � .� .. <br /> Oe4 <br /> ,a <br /> � f <br /> w. <br /> ,I } <br /> l' <br /> — -- _--- <br /> :27 ----- _.. <br /> Yi <br /> _______ ..... <br /> -------- <br /> d <br /> t _ <br /> e . <br /> CU21. , <br /> , <br /> -____._. . <br /> .__—_____ ___ .____ _______ - <br /> - <br /> v <br /> 14 s//� <br /> ------------- <br /> odd <br /> f_ <br /> • 5 <br /> Y , <br /> s <br /> . - <br /> . <br /> j <br /> -- - — <br /> • <br /> 4 9 <br />