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; 184161 ~ CERTIPICATE OF DEATH N~ 3067
D~portn~nt o~f i~se~ith
Regiater No.
THIS IS TO CL~RTIFY that ................1l~~.~it?l0?y...Wa~@~~5,~,.........................................................
Sca .......ma,].e Died on ..................,~iu$ust..26.,...1.96~~........................................
In GloversviUe County of F~ilton
and State of New Yoric, as shovm by the record of death filed ......Aug~,t$~r,.,~~_~,..~,,96?~?.., 19........
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with tbe registrar of Vital Statistics of this registration district. ~~:i ~,,r,~.xy~,r.'::
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Witness my signature this ..........................~x':d. day of ~'~4,~ti~'i~c~;;'~19.~Q..
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`JVarning: Any alteration invalidates this certificate.
FlLEO AND RECOROED°
ST. LUCtE COUNTY. FIA.
~S~CORC V~RIFIED
184161'
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1ZO~EP. r OIYR.;S
CLERK CIRCUI7 COURT;
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