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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Name of Decedent: Immigrant ID: LSNE-30OCT1909-3-1-0025 Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Name of Spouse: Immigrant ID: Name of Father: Immigrant ID: Birth Place: Name of Mother: Immigrant ID: Birth Place: Burial Place: Death Cause: myocarditis (contributory: broncho pneumonia)Comments: birth date: 15-May [year blank]