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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:                
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Residence Years:             

Name of Spouse:              
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Name of Father:              
Immigrant ID:                NYRK-31DEC1909-3-C3-0002 
Birth Place:                 

Name of Mother:              
Immigrant ID:                BRIT-05DEC1914-3-1-0024 
Birth Place:                 

Burial Place:                

Death Cause:
                             coronary occlusion, arteriosclerosis

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