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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: LLRN-07MAY1904-3-T-0015 Birth Place: Name of Mother: Immigrant ID: LGSC-13JUN1904-3-B-0001 Birth Place: Burial Place: Death Cause: internal hemmorhage (contributory: etopic)Comments: birth date: 15-Jul [year blank]