HomeMy WebLinkAbout07-06-10 105.805 REV (01/07)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.fJ0 'This is to certify that the information here given is
correctly copied from an original Certificate of Death
`duly filed with me as Local. Registrar. 'The original
- '»certificate will be forwarded to 'the State Vital
- records Office for permanent filing.
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P 1~35~55,0
Certification 'Number Local Registrar - Date Issued
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