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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Name of Decedent: Immigrant ID: OCNC-22SEP1909-3-C33-0023 Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Name of Spouse: Immigrant ID: ALIC-14MAR1912-3-54-0003 Name of Father: Immigrant ID: Birth Place: Name of Mother: Immigrant ID: Birth Place: Burial Place: Death Cause: chronic interstitial nephritis & hypertension (contributory: uremia)Comments: [mother's name is incorrect, that is his wife]