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~~'r''~ STATE OF NEW .JERSEY
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= OFFICE OF REGISTRAR OF V1TAL STATISTICS
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y that the tollowing is correctly copied from a record qf Death in my office. .
NAME OF DEGEASED PI.ACE OF DEATN DATE OF DEATH
Alice Rebecce? Worrell Oaean City, N. J. April 12, 1948
SOCIAL SECURII'Y NUMBER SEX COLOR MARITAL. CONDtT10N DATE OF BIRTH AGE
~ YRS. MOS. D71Y
F w Married July 3s 1892 55
PLACE OF BIRTH CAUSE OF OEATH
3wedesboro, N. J. Acute Dilatation of Heart
SUPPLEMENTAL INFORMATION IF DEATM WAS DUE TO.EXTERNAL CAU5E5
ACCI~ENT, SUICIDE OR HOMIGIDE DATE OF OCCURRENGE
SP ECI FY
WHERE OID INJURY OCGURI
GTY OR TO~M COUHTY STATE
DIO lNJURY OCCUR )N OR ABOUT HOME, ON FARM, IN INDUSTRIAL PLACE. IN PUBLIC PLAGEt
SPECIFY TYPE OF PLACE l
WHILE AT MfORK? MEANS OF INJURY i
NAME OF PERSON 1NH0 CHIiTIF1E0 CAUSE OF DEATH ADDRESS
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A. J. Smith, Coraner ~Oaean City, N. J.
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2~~0z Addre~as
~arch..?.~.~...197.~
......Date af Igsue
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Ufx£R RUSLIfNIHG CO , INC , 7N[MYQM, N. J.
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