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STATE OF MAINE
VS30 REV. 377
CERTIFIED ABSTRACT OF A CERTIFICATE OF DEATH
III OFFICE OF THE CLERK OF Sanford AIN -
,M E
Name of Deceased Sex Date of Death Age Date of Birth
Jose h E. W. Dai le M July 23, 1979 63 July 18, 1916
Place of Death State of f3irth Surviving Spouse
Sanford Maine Vermont Lillie Shields
Social Security No. Residence
033-09-1300 Tryon N.C.
father's Name Mother's Name
Louis Dai le Laura Savard
Cause of Death S .~uCEE ;,~..r~ ~ FAA.
Gram Negative Sepsis with RGG= ~ = ~..5
E:,. s , ;OUR
Severe Metabolic Acidocis REC~Q^ ~ t`
Dec 3 2 i~ PH `11
Ruptured Diverticulitis D Peritonitis 4~i'79'72
Coronary Artery Disease & AUD. J
Name of Physician
Robert P. Cote, M.D. Sanford, Maine
Name of Clerk Recording this Death Date Received by Local Registrar
J . Raymond Nadtati . ` ~ ~ ' ~ August 1 O, 1979
I HEREBY CfL~RYf~'Ii'~tiat fKe.'fbr~Qfng is a true abstract of a certificate of death
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which is In f11~ official custody.: i VOID IF ALTERED
ATTEST:_~._ OR ERA8ED
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CLERK OF Sanford Maine. DATE ISSiJED August lo, 1979
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