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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Name of Decedent: Immigrant ID: Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Name of Spouse: Immigrant ID: Name of Father: Immigrant ID: CHGO-29AUG1911-3-10-0004 Birth Place: Name of Mother: Immigrant ID: BRIT-08APR1921-3-7-0015 Birth Place: Burial Place: Death Cause: stillbornComments: filed in Vol. 62, p. 28 / first name: [blank]