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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: LLRN-10NOV1912-3-9-0027 Birth Place: Mother Name: Immigrant ID: LPRV-05JUL1913-3-9-0024 Birth Place: Burial Place: Death Cause: acute intestitinal intoxication with acidosis (contributory: broncho pneumonia)Comments: