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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: ETRU-26OCT1896-3--0060 Birth Place: Name of Mother: Immigrant ID: EDAM-20DEC1897-0-I-0027 Birth Place: Burial Place: Death Cause: aortic regurgitation / mitral stenosis / dilated heart (contributory: fatigue & heat)Comments: