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~ERTIFIEO COPY OF ENTRY IN THE REGISTER OF DEATHS. - BAHAMAS t~
THE BIRTHS AND DEATHS REGISTRATION ACT (GH. 121). 234083
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u4,M.E OF DECEASED Z
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S E x DATE OF DATE OF lrtTH ~ ~
MAR. ~ WIO. ? ' ~ A i
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M~ 1 ' ~ ~ ' p'AY~ AR ~
?:~CE OF DEATH - ~
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~ OCCUPATION ~ ~ . NMAE OF HUSdAND/WIfE OF DECEASED 't
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aUSE OP DEATH ~
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AMD RE
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~lN4ER F01T AS
NAME OF MOTHER ~MAIOEN NAME) RECORD Y.RIF1C0 ~
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:N CASE OF ~ ~
STill•BIRiH ~ ~ DAY MO. YEAt ;
PLEASE NAME OF FA7HER ~
C Ord~PIETE
r H IS DAY MO. YEAR i
ADDRESS - MOTMER ANOiOR FATHER SEJ( OF CHItO DA1E OF lrtTH/DEATM '
SfCTtON
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~ , CERTIFY THAT THE ABOVE PARTICULARS ARE TRUE ~
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THE BEST OF MY KNOWIEDGE AND bEl1EF_ • -
tURE U~ ~
; a~n SATISFIED AS TO TME CORRECTNESS AND ~
SUFFICIENCY OF THIS STATEMENT AND Of THE TM~ , Q~ pAY Q 14 ~
•.'.fDICAt CER IFICATE OF DEATH AND REGISTER THE DEATH.
:.c~iSTANT • • ,.Fj~.. . .
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;iSiR~R Q REGISTRAR ~
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"O~RECT~ONS '
C-oTIfI~D TQ BE A TRUE COPY ~AN E TRY IN TME REGISTER OF DEA1H5. 9
, ~ : ; N AT~S,~~LLL.L , Q~/L~Q~THIS ~ i ~.t.- DAY Of ~ 19~_ _ ~
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