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HomeMy WebLinkAbout0774 : ~t~~ aNS ~E ,~4s4 , ST. ~UCIE COU 1~~N~ (~ar~r, j~Q~,4Aa ~ REC4RD VER Departa~ent o! Health '66 .II1N 2~ A!r! 1 t' 06 _ ~42~9 ,~,i~~nl~ . . ~ . , - ` '.~s~•ti~~~ . 14 Certiliaats of Deat~ a. ti,+l ~+'t~,:.. R t : , ~L~O~~ ~ ~ . - THI ~Tthat our reoox~lt~ shrnr ~~*`.~~I ~~:~'~Ai~ --die~t gt . ~r+l ~ j`~ 1!.' ~ - 4l~.' lDOII j/ )f@8l" . O 9a'CYl 0 8¢ : _s :ii2'r' ~Y' . A~e at death ~ $ex Color ~illj ~?l~~11~`~ ~-+t'~,..:,.-~; e . y s• r;;'. Name o! HusbanQ or ~iile ~ ~ ~~~i ~ " ~.r~r~.~~~+i w~~~ ~ ~ ~r~.r~~.i. ' liy~~~~~~Ywr _ _ _ _ Primary ~aauss ot' cleath kae ~M~ ~M ~ i ~~~s ' Signed by • ~ ~~~a ~.~i• Sa~'l• , p a a sn or ~a ~of aer , s ess r; ~ir~sl Q~s~ ~s#7?• Place of burial or rs~s ~;x~~~~~~ oeastery a ees ` 1 - 2- ~ - ,Y Date of bttr~: ' ~ j+~ i~- : ;t.. sr reator ess . ~ - ~ . . - ~ ~.1.=4 ~ ' . . ~ ,rJ ,K, ~ . . ~ ' i'- . _~2~sanac~d,:.~R~b , J~y- oo num e~C page num er Y - Q t • . '.'t' tt • ~ • ~++~.f ~J ; ~ ~ ~ • ~ ~ ~ ~ S I~w 1 ~ - ' ~ ` ~ C E R T I l~ P' Yf~~ : ; d.! ~ . ~ I ~ ~ • K Ai~i~;^ , ' ' ¢ . ' o0 881 ~h Pt1C@r ~.1 e~~-e.~-~ ~"5~.:1 ~ ''r;,~'?~ t ~ HEALTH SEW[At j w9~~'~i~~t~ 1 I- 1 ~ 6 v ` . CITY OF GARY~'~j,,•,`•• . e isaue ; ~ . ~ ~ ~ ' : . , ~149 - - _ - - _ DATE . .L . . . . . : . . . . . . . . . fi7GA0FII~[ Ytii~p _ _ - . . _ _ _ Le~ibili~y ~t wtfti _ ~ - _ a6 • ~j'Pini or printinb? unsatistacLory in _ . _ thi doct~ent for micr~lilmino ; - - - ------~...~w-- - f~' r . ~ _