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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Name of Decedent: Immigrant ID: IVER-05OCT1912-3-T6-0028 Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Name of Spouse: Immigrant ID: CYMR-12NOV1904-3-R-0009 CYMR-14DEC1904-3-C-0028 Name of Father: Immigrant ID: Birth Place: Name of Mother: Immigrant ID: IVER-05OCT1912-3-T6-0027 Birth Place: Burial Place: Death Cause: puerperal peritonitis (contributory: miscarriage)Comments: