Death ID:                    

Certificate Location:        
Certificate Number:          

Death Location:              
Death Address:               
Death Date:                  
Informant:                   

Decedent Name:               
Immigrant ID:                CYMR-12NOV1904-3-Q-0001 
Sex:                         
Marital Status:              
Age (Birth Date):            
Occupation:                  
Home Address:                
Birth Place:                 
Residence Years:             

Spouse Name:                 
Immigrant ID:                PHIL-17OCT1908-3-C5-0006 

Father Name:                 
Immigrant ID:                PHIL-17OCT1908-3-C5-0002 
Birth Place:                 

Mother Name:                 
Immigrant ID:                PHIL-17OCT1908-3-C5-0003 
Birth Place:                 

Burial Place:                

Death Cause:
                             cerebral hemorrhage (contributory: belated hypostatic pneumonia, inanition)

Comments:
                             wife's age: 53 years / wife's maiden name: Harrootian [Haroutiunian]