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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Name of Decedent: Immigrant ID: DOMI-29NOV1911-2-E-0017 Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Name of Spouse: Immigrant ID: ASIA-14FEB1921-3-20-0003 Name of Father: Immigrant ID: Birth Place: Name of Mother: Immigrant ID: ARBC-02NOV1911-2-5-0028 Birth Place: Burial Place: Death Cause: furuncle of upper lip, contributory: cavernous sinus thrombosisComments: