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fl~EO AN:' kECOROED
~~p ~Dt~AtUlt~~ D~ ~~~Mt~1i~P~8 sT. aoc~~~0c ~a~s L~.
CLEP.~ C~ ::.4iT COURT
UNITED 3TATES OF AMEBICA . af c:~ v: ; c:
COPY OF RECORD OF DEATH 1 I~~ o AH 3
ro.~ soucb~.ck 24942
.........................~-------~of........._...........---.._..._.............. -
I, the undersigned, hereby certify that I am clerk of the.._
~Q'~[aL.__..oi..w.._ S~1iLh1L~.C~.._.... 9
th~t sa such I have custody of the records of deaths required by law to be kept in my oSice ;
that among such recorda is one relating to the death of
..................................~'!~~~.hit.a~..~ix.Q~l~..~C~......................................................
and that Lhe fullowing is a true copy of so much of said record a4 relates to said deatb. namelq;
Date of death......... JiDtilt!!~..13 R..1~
Place of death......... ~~!~K~.~e~.~.
Name Mia~el xichard ~raneia
.
IE deoeased 'u a wrried. ~ridoeed x di~aoed rra~f. ti~e al~e ~aide~ aa~e ~ad a~ae ~t i~~L
Mals Color ~te
Sez
Single, Married, Widowed or Divorced ~i.".2'3ed -
Age 5? Years Months .............a Day s -
Southwi~k, l~aee.
Residence
Occupation 3elf-emplo~ed Gas Stattoa
U. S. War Veteran .
Auatria Hung,~~i''
Place of Birth .
FATHER ~ ~ MOTHER
J~hit Ferantovi$ ~
Name ~ ~faiden Name ~Lh~`iAe Sllmak
----...___.__.____.___.......w.
Auetria H i Auatria H
~
' PTace of Birth--_-----•--•--._~_._~_ Place of Birth---...__..__._---._._._~_. ~B~~.._._.._.._._._
,
C~use of Death .......Co~*ot~itl~..4cclu~aion
P~ac~ of Burisl SoutbrriCk,~ , t~.itss, Ceme .
.Nsme of Cemetery ..1~s1I Le1~?
.
Date of Record_........, January 15 ~~~0
,
And I de hereby certify that the foregoing is a true oopy irom said records.
~ SouthxiClt
` ~ ~Ittus~ mY hand and aeai of said ?o~ of..
5~~.,' -
. - . on this ~ _ of April 19 ~
- ,
~ 19b0 ~ ~ ~
Year,~ L . .
Vol... - ~k
Page._.. - -
No. soo~2i1 ~?c~2355
fOVM 43t Hosss e Wwraea. Iwt pu~u~iet~
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