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y - 3Y Cr:'TIFY THAT the foregoing is a true and correct copy o~the de3tn
:ec~:rd for the decede-:t named in item I and that this record vas established `
•.n filed in my office in accord-:nce with the provisions of the Illinois ~1
~ tes rel atinf: t~ the registration of births, st' llbirth aths.
8
JAN ~ 1918. signe~
;.t ~:ook County Depart~,~ent of Public Health Off cial Title Chief Deputy HeRistrar - -
NCO .Lset Jackson Boulevard Chicano, Ill. f.06A6
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