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_ ~ ~ , • ~ ' ~ , _ • . . t. y ' ~ OI~FICL QF xHE EtL;G~:iTKAR 0~' VITAL S'TA7'I~TTC3 C` ~rt~~r?~sti IP nl~ I.~~c~wooD, NL~ S1;RSEX Ot1101 . `I'him 1s tn certii'y tt~r~t the r~1~ awit~~ is ~ tru~ copy ~..:~:1~,`,~. oi' a rs oord f ile+~ in ~hi ~ c~i'i'ice. .~.~,4~.;<.>.- , :.;~.a.~.~.,~ IAS~.itI1( t::'i}t-I _ ~ ~ ,'`~,`':i~~~ ~I?~~/a~~••~t • ,,~zsa,~ ~ ' ~.r r.l...,t'~,~~~ , , , ; ~ . • ; ~ ~ ' . " ~ ~ `?t~~ . ~ a , rr . M~_ ~ ' ; . . ; . . „ ~ ~ ~ -r:,~, . , ' ' ~P i~ , , ; . . . , , , t-~'y:`;~ : r1 ~1~~NING 1: 1 1 II(1 :~Or ACGk P~1' ~1'tllS t,UYY UNT.E.~3 Tr~~ itAISFf~ SEAL U~;}.~,~~;'~~~. itl;r~ iS~PFiAR x:~ AT~I~ 1~Ck,t~ Hi?RI~,ON n•..l .'~p; n~'•~~z_~>-``,, . . . _ - • . • s • - - - - - --~f1!' ~T '~.p y" T~~'~.~~r - - 1{ ~ . ' - _ . 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D spuvt o~ ~ pE,~,~~~ ~?2b_ Name of CemeterYOr G~ematay ; 22c C~ty w luhn y 22d Sute y j ~~46ur~a1 C) UtAet: ~ I ~ ' t C emat on ' ~ Q ~ ` - _ ~Ldlc?G~D~f~stl--- _ _ t~C_~?C1Q,-- - - H. ~7- j pe_ACE oe • r i 233 Nime end 14hiress et Fu~zat Home . Sf lae i n~ p+rectw ~ 23c N J. l~cens¢ No. ~ f AGCIflEM! ~ %~/ig FVN(~.~ql ~?7~ t ~ ~ ~ _ ~a - -a-~~-Y-----s ~ - - - - - - o ( f ?fIII~70~ ~ a. slure o) Reyist~~t ~ ~ . Oate ~euned b~ i i eROSS c~~ss 4 LAk 't~UCUO N• ~ ; Reg,u~:~ ' a13?O/ ~ - - 1~~' I f ~sM AA6rta Ciiti ~ Pf~yt. Q E~~~t~ ZSb. To tlr~ . • . Oi~s ra D`~ct n~~(1 ~nree t ~ • ' ~ , S • ' F { ' - ~ - - ~ e ~ r 25e. Ilste 6+. of I6b. Ptonounced De~d , ~ ~ . , s-~ , ~ r~: ~A , ~ , ~ E 27a. PAAT 1~med~~t~Guse 2tef only one qer lina ta (~1. ibl, le . Inun~l Getrtm anset de~th ~ 3 c ~ ~ l~ ' q~ ~ ~ y`" ` i.l'~~- ~ ~ ~.,~;~~o~ ~j~l.dwrG ~ . .~oni . ~~yi/~j ...~.s ~ ~ J W JS ~ UMIKI`f1Ct C2 dI ~ ~j ~ . 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