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CERTIF'ICATE
OF A
RECORD OF DEATH
AS RF.CORUED IN THB OF~ICE OF TH8 CITY CI.SRK
CITY OF' NASHUA
COUNTY OF HILLSBOROUGH STATE O~ NEW HAMPSHIRE
IImma Dery
Name . .
n3« ~ u~te S~eptember 2b~ IgbO
Pi:~~ ot n«~ ...................Nashua,....~Tex...Henap.shir.a...........----
s;,,~~ v~, .....7.
s~: ...F........ co~or ....W.._.._. oi ..M,a.r...... Aae MoAeb,
M ' Days
ou~~uoo ..House~if.e......... s;~ebpvu ..Roa~an..Fe~1~.~.,.P. .
vi~ea~e or C:we o~f ve:th .........581?.~.l~,.tiy.....:....Ax:.~'eAl`.1t.~79.C~.RlX`o is
.......G.er.ebxal....thr~m?~aaia.....-....~arr~ia~a.__Ac...San~.l..
....................~ailur.e....-...._..CQr.anar,y....Q.cc1~~a3.AZi...............
Namc d Father .....••••...........~A.4~~~'1...B8AO~.fr
Maiden Naa~e o[ l~iot6er .......AdB1.~~.C~9...M~~.~]l2.te
Death Reported by ....................NQI'lII~A...Cii2:~.w9~~.••-....••-•••...... M. D.
Date ot Burial .......~l~jl.ti.fl~T@.I'....Z9.~....a..~~Q..................
'i Place d Burial ........~~i,9~1~~.~...~~.~~....•••............................
~ rtame or eemetery .....................S.~i......L~Q11.~..~....d.Q....~itQS~7wS1g.11.A.....
C Undertaker ...............................~.U1'.~..~c~_..~r.w....~Q~.~r.~~~...........
I t .
't
~ ~ ........~aK~ -s...-.;.~~,~o.~ ~ ~d
E u~ t6at I hoid tbe d~ct a~'City Clet~ in tDe.C~ty County aad State afore-
~ uid, and that the i is s tnu ovpy from tft~ recordi of the City oE
Nashua. - ~
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fqttIRWIT C~~~~
~ RECOR~ VER'F'E~_ ~ I~
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