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f <br /> Form R-323. 2m-2.59-924805 <br /> r <br /> of <br /> } ' (LSE TWO LINES WHERE NECESSARY,ALL NAMES TO BE GIVEN IN FULL.) <br /> b DATE OF FULL NAME OF DECEASED ? j &netdherstn AGE <br /> DISEASE OR CAUSE OF DEATH <br /> ! NUMBER j DEA (If a married or divorced woman or a widow, also <br /> SEX 3 COLOR wtdc or (Primary and immediate cats) <br /> II , maiden name and name of husband.) Years Months Days <br /> 7 divorced <br /> ,� ,� �� � ��/9__� ZcJ• �v• _ �? k/ i _1`'l_ _.S�l ,S _ �.5�_` Com. _ _ _ <br /> } <br /> s <br /> � b ' <br /> 1 � <br /> j <br /> t <br /> j no <br /> J—3 <br /> /t <br /> b <br /> H � <br /> y 7 � <br /> b ' A <br /> tigqj1 , <br /> . � e <br /> : <br /> p <br /> �a c S <br /> ---- <br /> f <br /> t <br /> R <br /> •,� f <br /> x;. <br /> " e <br /> t i <br /> =a <br /> 4. <br /> i <br />