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'~f' .. 2~:~~', 2dC><p Place of death A,'.r/ert..,) ji./r .lVt--:{E d c. ).l..~ V\ -<__~~__~~ City or Village ' HCiI'0/lfOA) County ITEMS to BE CORRECTED OR ADDED If,~rn. _.. _.L.: ' .1 . __ Aeads as o /!j/O Should mad _ F t.. <:~l ~2 I b A .___ Reads as IId:~1/J /'(lo~J.____ Should real1._~. {! 0 il/ e r lil!rn .~ I IIE.m.. .. .__ Fiends as 4A1de../:s;o AJ -r LVp..., Should ,mld A0:/y/e 5 ' __ noad... fz,1. g;;- "0/" !i~ ~ ~I,j read ,32 :5 II ep/;4Ne:> ._~_ Readsas~~-:A:Jtt:> ~~ ~louJd maLl 3'4/f.>'J , B~hi I~ern .. ___.._.{ /1(' 1rUITl _..... L ~;~... /. h__ ',' '" --,.....-. {} !It PEf<SONSWEAAING TOTf;fEAEJOVE FACTS ......~ .-.: ~ ~/ ,-' 'Kohc:le;; . being first duly ~rn ~ay lhttt I, .n__. .:,,"':::'>.::~~~:':':~,~/..!; {,j l:J~me "'a:~'o":::~<~~"'~ri?, ,~ _,:~!~ - 'NO a'id~~e~ ......-., , .~f;;;rsQfl(s}execUlil1gatii(j--;V;1 '. ., ( , . . ,~..:.".' l+G,;\,..Q.....y;.:, , . ' .. .-.-..- ' I ' . Sigr.atlJrlI:~ NdtaJy ___ ' I ~~/4;la(p . OJt../g~d () 2 .2;~ ~;2 0 c Of , I . Dafeca{~fohexpires \ I" ' G 2~ ~ a. c i! I ~ IIII ~1111111111~111111~11~ljllllll ;~ .' -; ..I( :i I Ii ., " UIIIIIIIIIIIUIIIIIIII, 11111111 PRESENC 0 I.~ WATERMARK IIII~I~I HOl TO LIGHT TO VIE .IMlllllltllllllllll.llll-