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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Decedent Name: Immigrant ID: Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Spouse Name: Immigrant ID: Father Name: Immigrant ID: ROMA-06AUG1913-3-11-0006 MGHL-01OCT1921-2-C3-0015 Birth Place: Mother Name: Immigrant ID: MGHL-01OCT1921-2-C3-0016 Birth Place: Burial Place: Death Cause: hydronephrosis r[igh]t / pyonephrosis l[ef]t / marasmus / phimosinComments: [mother's name Margaret crossed off]