|
, .�:: . , ' .
<br /> r�,�� . ...
<br /> • • X��: . ' . . . ., . . • ^•.:,��� '
<br /> .�... a r.�.. .� - . , e ... . �--- � _�., __ ..,�,- --
<br />-"�}• '- - . - , .� ��._a��-`"'=1. . .. ., '� .v,. . ,.. , , a . 1e �- .,. . . .a = _ "."r .._
<br /> �
<br /> �• � �• .,•
<br /> . �
<br /> ' �,r.i, �, - . �:r*-�-
<br /> r�' _ .g .. .. ._ . .. r-. --
<br /> ,� . . : .. .n . „ , .. . . .... .--�rs,. - J . -
<br /> ,r` ,
<br /> ' - . � .. , . �• , ., �• _rey�-�st��ir�
<br /> ............ ...... ....... .... .. . . . ..._............._.._,... ..._' _""'"",_'-_S�_—"'......_.'.�..-_.___..._......_ '.."'.�.. ,._..'___'_'_�...]Yl4'3P=':.Ja.yfr.�!!rs+�,.. �- _
<br /> .:�''��.:t..%>rr,'. ,i_.,. �•�
<br /> ,'�
<br /> , . � ►`��•~ 1U9�"4� .--=
<br /> 33. NAME OF DECCNOENT --
<br /> For use by physlcion,medicel examineror county caronar.
<br /> . � � . • m .FOR VITALvSTATISTICS.US�E ONLY , � : ; a � � o z p N --.
<br /> ; � � ' � �- � a � =� —
<br /> ,. � < � � �
<br /> , , � i � � �
<br /> 6 . �' . . . . . . . . . . . . . . . �
<br /> � ��
<br /> ° • � . . . . . . . ' �`: . . . . . . • ' . . .
<br /> ' � R SiCCC�rJ 1 F ° a� y �'�' � • • * �" P 7+ R V � {{{((( R � _.
<br /> i y � Q[�
<br /> . ' ' '�,'�•`i � � � 11 � ' �v�� � O��n �� O�� l r M � „ ��O �� 9 ��� ��� V �� p^� � �
<br /> tl M � 00
<br /> � � r�: s�,,, � g �.� "pR � ►��i �.�t'N N� G fn ►
<br /> � b � � E E �fa.�� g oo � ' �i � �� � ro�� rt 3 � w �u' �" y
<br /> . � , � � � � �� � R ��p � 6o ba. �~ �� ~�� fD ��' �R �o � R � _
<br /> h � n ' n i 85 f17 � � r o �o _
<br /> ^ $ � 4 W �O �
<br /> . � � � �� � � �� g C r"1 • � �N C „ �� � y r+ � � �
<br /> � � � d �
<br /> � �� � � � � � � �. � � ;� � � N 1c ; ,� -
<br /> � ��F1 �� � w k� a � e� Oi � N
<br /> . .. � � � � O (I W a„' � x �¢j rl � W �
<br /> N 7 E Q !F�
<br /> M, � o � � ` ��Q � 7 R/~p � W � �y � j"�� �n � '�
<br /> - � - � $ � � � ��,� � � � 2 c. o � %? � � g� I � 9 _
<br /> � o Q � a i R � �, � �+. � �v • -�
<br /> p � � Q ��0 � R � � � � ry a � � �� � --
<br /> p. � � � � � N � fpf� � � � p �{ a _
<br /> r' � � � � p L' O p p oo p II R 3IC � n�e Q-
<br /> � $ � a � a � � � fD N �� i C fµ! � �M �� � q ~L'� * E
<br /> O
<br /> �' � � e � � ►-' �^ �� �. � a �� �� �� f � �:-.
<br /> . p' o ° $ � �. � w g � °' $�. �n F � �i-+ �r+ Q � o ��
<br /> o � � � °o Q Q a � � ��d c° ' _ w P fA �' F w ��I �� ',
<br /> mg � � '+ �� �p' �t � ~ � "p �� � � � F'' � ��Y
<br /> . r+. � $ '�„�a,,, � 3 _ � �o �� . q ��a a ��� � •=
<br /> �' a Y �ro � � � -
<br /> . � R � doou��naaer y �� b h ,�i � � 7, �� �7 rt � .
<br /> a' � � � �
<br /> d ��y � � � ::" �� � � �� �o �r�' �cwn � h� a, � � � -
<br /> � � �' ° o� N R �' � r'�� h � � � ��j TM�;,
<br /> p�i � ,�t� � �w w � 8 �� � w � n � a,� g' � K .�.� "Sp' $
<br /> M S � 1 � r'► r'f � � �-+ 9�' "" n o --� h+ it
<br /> �. Q.� h x
<br /> � � � �p o _ � � �� w � � � � � � �° � ,
<br /> � fD � �f � �V �� � . � Lz7 H n � � �
<br /> � ' QA q �4 .'gM "oW � � N � �51�.) � � �p� . ��tC� .
<br /> �� a a �' ` � °�' � s w g n E a' �1� �aRi'Q a. ��.. � �� "� "�'' °>
<br /> . � � � g° , a gz�� �w � g w �o �w � �o Q� �
<br /> o �� rn o '� Ul �p �UI � tA R �• �,
<br /> � w � H �o o � Q` n ga R o � � � 8�' � �� H g �
<br />_ N CJ i� � � ` N �!-� fD 4 • 4 M � fD �p� �+ � � -ty .
<br /> � � � �9 8 �w a~ � � -- - - G] o�N-+ G9 � � q a C�7 m M � � � ��-'
<br /> �-i � O� F � y O N � �'1 a G q M f0 g - • � � �
<br /> 6 � g �N$ .. o .. Ta, ��� � � � �� � � s"�a �� o�M, � �R � �,
<br /> �°°§„' ` ° �
<br /> aw Nn v, � o � a o-r� r �x � a � a � p � �<
<br /> - = p, � ro � � _ � � e °vg� � �� � �' �� �`� � � fD � p g � �
<br /> • 7c N�r o �g p wrn� wrn� _ 'a I
<br /> . d• � ry � � '�m
<br /> �� � zn
<br /> � � ' �4 � s n � ! � t C►0o L110C� � R �N 0�
<br /> I'� rC n o r n e�s �p O y �
<br /> . 7 w ro �n � ro p '^ -
<br /> µ � O 00 N � 5 4� 5 �'�� ��~ d� �
<br /> , p �
<br /> i
<br /> �
<br /> f+
<br /> 1
<br /> 1
<br /> � �
<br /> _� _...
<br />
|