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A VERIFIED TRANSCRIPT FROM THE REQISTER OF DEATHS
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Oate of Death ~P tembeT.. SR..lq68..........:
Katherine M. Campbell ~
Name of Deoeascd ~
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Ape .......$Q Years Montln Days
Singie, Married. Widowsd (lndicste by S., M., W.) ..1'~arried
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Rsce or Color, if other than white
Ooa,paaon ......Housework..~Oxn..homel ~ ~
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Birthplaos ~r~land #
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~ : 1~r~~txq~~c..~~~..:a~a....NA.....Q.?.?.-07.-9.4$,~A :
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° Father s Name ~UnknoMn) ~illiams
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Mothe?'s Ma+den Name ~~Se Busher ~
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Plaoe of Death .~5~~. I.'On~ Island Hospital ~ Greenport ~ N. Y. ~
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' Chronic M ocarditis #
i Chief Cause of Ossth .......................X..................................................................... ~
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Time from Attadc till Death - Duntion ~
~ Nkdicsl Attendant. or otha~ AttestsntN.M.Sperling~K.D..Greenport,N.Y.
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` P1aoe of Burisl Cutcho~ue . Cemeter~r. Cutchogue. N. Y. ~
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1 hereby sotemnly attest thst thh i~i:KUR.~~~Pt from the Public Register of ~
Deaths as kept in the G et ~Is~lc't Offic~, County of Suffollc. State ~
of New Yak. ~ ~ , _ l~ $ ~
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; t .:.it ~ .rR~e4~Gd
' ~y; - ~ttil~i ~~4~'Vit~I~StatistiCS. Villapa of Greenport :t
Oated at Greenport,~N:,Y. ` 7 ; - `
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the 21st...y` `r ~ . ~anuary............. t9 1....... ~
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St. LUCIE COUMTY lA. ~
ROCER ~'OITBAS
CIE~K CIFtCU1T COURt
RECORD VEa1F1E0
Ju+ 19 3~9 PN' T I
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