Death ID:                    

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Death Date:                  
Informant:                   



Name of Decedent:            
Immigrant ID:                STAT-27JUL1902-0-A-0022 VOLT-08AUG1910-3-C3-0016 
Sex:                         
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Age (Birth Date):            
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Name of Spouse:              
Immigrant ID:                VOLT-08AUG1910-3-C3-0017 

Name of Father:              
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Name of Mother:              
Immigrant ID:                
Birth Place:                 

Burial Place:                

Death Cause:
                             myocardial degeneration due to arterio sclerosis

Comments:
                             [age and birth year are not consistent]