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THIS IS TO ~CERTIF~' THAT THE FOLLOWIiIG ZS A TRUE COPY OF le RECORD FILED IN
THIS, ~EP 1'~NT~.~~~WARNI?~:1 : DQ 2JQT ACCE°m mu j~ r py U;ILES~ T};E RAI~E~ SEAL
0~ THE ~~~UA~]Ntl~ OWNSHIP HEALTH DEPARTMEP~T AFFIXED }iEREOi~ .
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NEW JERSEY STATE DEYARTYENT OF HEALTH
CERTIFlCATE OF OEATH
1. NAME OF OECEASEO /F'rW plid~/ /~J Z p/-TE OF DEATH
RUTH 0. BENTZEN ~3-3 -80
3~. P~ACE Of OEATH IGry a Towm) 3Q County !a, Resdw.Q (No_ an0 St) ~b. Gq « Tow~
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FEMALE 9-24-02
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1?a Brn~piace (Su~e a Fae»n Go„nurl t?e Gt~m~ of wAat Canv~ ti Sw.srq Spouu Ilf Mt~h. MWn~ ttanrl 1~. SoeW Sw~itp llw~~
JERSEY CITY,N.J. U.S. IIJALMAR HOLT BENTZEN 140-30-1961
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= MAGNUS G. OLSEN _ _ .SOPHIE GRUNDEVIK
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POMPTON PLAINS
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