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CERTIFICATE OF DEATH
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- STONEHAM, MASSACHUSETTS, U. S. A. ,
1. Date of Death December 31, 196?
2 Name of Decessed Samuel Percy Davies
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Maiden Name
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3. Sex. and whether Single Male Golor white
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Marcied or R/idowed W id owe d
4. Age ..~9 ............Years._.........._.......~.__...-----Montbs......_~~9 --._...__...~Days
5. Disease or Cause of Death Arteriosclerotic heart disease .
6. Residence Rockland , Mass .
OCCUpation . . Chairman_ of...Bo~rd . . _ .
8. P1ace of Dtath Stoneham, Mass .
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FtLEO aM~ RECO~OEO
9. Placx of Birt6 ~1Elsnpool Wales sT.LUCiE COUNIY flA.
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RnC~;.'? ul'i'r(XS
10. N2tme of HUSband oi Wife Elizabeth Berry CLERK ;.,H~u:t couRt
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11. Name of Father walter J. Davies ~
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12. Name of Mother tM.~a~n xame) Janet Robertson
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13. Bitthplace of Fathet welshpool, ~ales ,
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14. Birthplace of Mother Dudley, England
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15. Place of lnterment ':~Selrose , Mass .
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I Ninthrop A .McCar:hY..~ . , .
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depo~e and say that I hold the oflioe of Town qerk of the,r~.'~sSt~one6aon,
County of Middle~ac and Commo~nwailth of Massachuset~ thaC : t~~;
~#~c~+d~ of Births,
Marriages and Death9 required by law to be kept in said To~m,ue in my , ,.:u~ tbat the
above is a true extracx from the records of Deaths in said Town. as ~'me.
WrtrtESS my hand and the seat of said To~.
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an che... ioth . day-of.. .~,1.~ .............:..~1a~.u~;~, ~.....---~-~---........._19 . 68 '
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