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Certificate Location:        
Certificate Number:          

Death Location:              
Death Address:               
Death Date:                  
Informant:                   

Name of Decedent:            
Immigrant ID:                ARGE-05DEC1913-3-37-0003 
Sex:                         
Marital Status:              
Age (Birth Date):            
Occupation:                  
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Name of Spouse:              
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Name of Father:              
Immigrant ID:                
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Name of Mother:              
Immigrant ID:                ARGE-05DEC1913-3-37-0002 
Birth Place:                 

Burial Place:                

Death Cause:
                             cold followed by measles

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