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Death Address:               
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Informant:                   

Name of Decedent:            
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Name of Father:              
Immigrant ID:                PATR-10MAR1906-3-92-0014 
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Name of Mother:              
Immigrant ID:                MLTA-08SEP1923-3-0-0313 
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Death Cause:
                             bronchopneumonia (contributory: parenteral diarrhea)

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