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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Decedent Name: Immigrant ID: LCHM-21OCT1895-3--0417 DOMI-29NOV1911-2-A-0014 Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Spouse Name: Immigrant ID: DOMI-29NOV1911-2-A-0015 Father Name: Immigrant ID: Birth Place: Mother Name: Immigrant ID: Birth Place: Burial Place: Death Cause: psychotic exhaustion due to manic depressive psychosis (other: generalized arteriosclerosis)Comments: informant: hospital records / in state since 1901