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241418
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CITY OF LOWELL
Office of City Clerk C t. 26 ~ ly`~2
CERTIFICATE OF RECORD OF DEATH
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Name Age Yrs. b1os. Days
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Date of r'r~I''-~~="Y ~ l~?t~ j Date of r'e'~r•~.~~arv Z2 ~ L`~t»
Death Record
Single, Married
~•~31C Color or i 1 t C Widowed or i'4t lr ~j
Sex
Race Divorced
73 .~icrnt~~ar? tu~. Cn~lmsiorc~, ?~:-~ss.
Residence
i 1'OWC~ 1 i;~~e.=al :io:~~., Lo~r~ll, i•:;~:~
j Place of Death
~ Name of 1: 1',~1'~L;'~T'2'~lt~l:`2'S
~ \taiden Name Husband €
~ or Wife !
~ Cl~r~-ys...~n ChPlsr:a, i.~:ss. `
Occupation ~ Birthplace ;
l~Iame of Maiden Name
~ Father i'r'~'•~~~1ri r.11t0[7 -~lat]C of Mother 1'~~ z ~1~~-Vt'S
Birthplace ~~G 3t0 ri~ ~5. Birthplace t~.A 7S<3 C'1t1 ~r Lt ~
of Father of Mother
(.~irc::ic :~-p'tiresclerosi~
Disease or Cause of Death
Plare of Burial or Removal i~~lr; ~ ~'r'j:~etery ~ JO 1tt1bCT'G ~ 3S.
I certify the foregoing to be a true extract from the Record of Deaths in the City of Lowell.
WITNESS, the seal of the City of Lowell.
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ROGE~ ~~tijRAS
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