HomeMy WebLinkAbout10-09-12HI05.805 REV (9/11)
LO A-R'S CERTIFICATION OF DEATH
WA J ("~Fi`I?"- duplicate this copy by photostat or photograph,
Fee for this certificate, $6.00. ~Q ~ Z Q - ~ ' `~a"~-~}'Q f~'$ This is to certify that the information here given is
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OAPW~W'S (;OURT
P 18 5 9 7 81 ~~~ ~~~
Certification Number
correctly copied from an ongmal Certificate of Death
duly filed with me as Local Registraz. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
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Local Regish~ar Date Issued
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