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STATEMlfv�dFA` 200312745 <br />SS. <br />COUNT Y`0: i3OUdISTED <br />herer cbrtify'th±at the within is a true, full and complete photocopy of <br />the o ,ce.rtr icat(vbf li#e -bj4th -death received from the Local <br />Registrar laj-#e Ciity'df f3oche,ster on the day of <br />19 2_ and thereafter transmitted <br />to the State'Departiiierlt of Health. <br />JOHN McrALLY. Clerk <br />Date_ ll -y -?b By <br />