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CERTIFIED COPY Of ENTRY IN THE REGISTER OF DEATHS. - BAHAMAS r~~~ry f
THE BIRTHS AND DEATHS REGISTRATION ACT (CH. 121). ~rWO `S
uq~nE OF DECEASED
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SEx ~ W~ ~ DATE OF DEATH DAIE OF A(3E
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~~1L(~JG SM• ? DN- ? DAY MONTH YEAR DAY A60NTH YEAR J O
PIACE OF UEATM ORDpiAM RESIDENCE
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'i O~CU TqN NAME OF SMND/WKE OF DEC
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~ FIlEO R D ~EC~7Rt~ED
ST. LUCI~ COUNTIf FLA. `
~ NAME OF MOTHER (MAIUEN NAM~ CLERK CI iLU~j COUR~
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~ STlll-BIRTH ~ ? ? DAY MO. YEAR f
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PIEASE NAME Oi FAtHER . • ~
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~ COMPIETE 2258'75
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~ AODRESS - MOTMER AND/OR fATHER SfX OF CHILD OAiE OF bIRTH/OEATH ;
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! CERTIFY THAT TME ABOVE PARTICUURS ARE TRUE
TO THE BEST OF MY KNOWLEDGE AND BEItEF.
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- 1 AM SATISFIED AS TO THE CORRECTNESS AND ~ /
SUFFICIENCY OF THIS STAIEMENT AND OF THE rHa ~ DAY OF 19~
~~{EDIUL CERTIFI ATE Of UEATH D REGISTER THE DEATH. '
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~EGISTRAR ~ REGISTRAR ' ~,~OL~IGa~K/
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~ CORRECilONS
c-FRTIFIEO T E~ A TRUE~ ~COPY f N E~NT~RY AIN THE REGISIER Of H5. •
k~ ~>~VEN AT J~~~~/+w~ ~~~~I'~Q.I7~" THIS~DAY OF_~ 19~~ , _
REGtSTRA GfNERAI
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