Death ID:                    

Certificate Location:        
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Death Location:              
Death Address:               
Death Date:                  
Informant:                   



Name of Decedent:            
Immigrant ID:                TNMR-03JUN1919-3-29-0013 
Sex:                         
Marital Status:              
Age (Birth Date):            
Occupation:                  
Home Address:                
Birth Place:                 
Residence Years:             

Name of Spouse:              
Immigrant ID:                TNMR-03JUN1919-3-29-0014 

Name of Father:              
Immigrant ID:                
Birth Place:                 

Name of Mother:              
Immigrant ID:                
Birth Place:                 

Burial Place:                

Death Cause:
                             lobar pneumonia, upper left lung & auricular fibrillation

Comments:
                             wife's age: 50 years