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UNITED STATES OF AMERICA i
COPY OF RECORD OF DEATH ,
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1. the undersigned, hereby certify that i am clerk of the of
that as such 1 have custody of the records of deaths required by Iaw to be kept in my oftice; that among such retords is
one reiating to the desth of
Le.~1s N. Gt?OdY~? i~
and that the following is a true copy of so much of said record as celates to said death, namely;
Date ofdesth ...............`~ctcber..2j.,...,.~56........................................................
Place of death ~ o s t::??.t... Ma s s..................................................................
~,e:~-is G,aodr.in
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Name ~•Jr~D
aECOR F~A.
tf deceased is a married, widowed or divorced woman. 6ire also maiden name and name o~~1~~ G~V~~
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Sex ..................M~:~.~.~..--•-.......................... Color ......yr~i~:~e..........................~~R1~.6ic;L'IT GOU
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! Married, Widowed or Divorced ;:arried Rc~~RD V~= "`n
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~ Single,
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..................Yesrs 3.......--- Months i 3 1 i ki AM Z Z
t .t:~ :isr~.:J 2;{s. .t
:r:......?
Residence '
; ........•--••~'ato..~ealer .
tion z~~~,~
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z U. S. War Veteran
~ s:nitc~::~:~, M~ss sa~~rywu
€ Plaoe of Birth
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~ FATHER MOTHER
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~ ......:~e~l::::l.~...::.'...~',~oc;~v::n-• MaidenName..~'ertrude..G.....FuI?erton..............
~ PlaceofBerth 'e~.ocdy.~.. Mass Placeofbirth...r~areham, Mass..................................
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~ :~o~,.- foc~.r~.~«_ ar~ lon. :'u_:~:an~ry ~..eTMa azic con~es ion sev .
,e Cause of Dath
~ P~ce of Bw~ial :hi t:~:..:'.r... r'~ ~ Name of Cemetery ....:.''1... n..:: t.......................................
~
~ Date ot Record .......A
~ C.~...x~..,. .:i.:: ~ u
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And [ do hereby certify that the foregoing i~ a tn~e copy from ssid records.
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. itrit8s my hand and seal of said........ :'..........of
;s , • 2;=nd Dece~~ber ...........19 7,
_ . on this ........................................day of...................:.:
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