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, STA7E OF MAINE . vs.ao
~ ~ CERTIFIED ABSTRACT OF A CERTIFiCATE Of DEATH ~
~ OFFICE OF THf CIERK OF E u S~ ~ S , NUINE
Name of Deceased Sex Date of Death ~ Ags ~ Date of BRth
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Place of Death State of Birth
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Soc~al Seaurily No. Residenoe
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father's Name Mother's Name '
W~ I-~'r~d t2o c~c~ P rs /'~lae ~a son _ -
Cause of Death .
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Name of Physician
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'I N a ~ ihi~' Death ' Date Received by Local Regishx -
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~ - ~ CNttlFY that the foregoing is a true abstract of a certificate oF death
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~ , =CIHtIC Of.' MaK~e, DATE ISSU~~_1~~
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