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<br />'::\\}' of Boy Gill'" _ .,
<br />'eouoty O(M~Ulllott!(\.""
<br />il, C~r:':B~~Sb\on, 'tt.;!list,'nr 01 VltJll
<br />Sta~Jt ..~Jrorl't!1e ClIy 01 Be CUy, Texu,
<br />n~ ~:~.f,tius(9.'i1',]~~~py 01 th D~a, "ql. \
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<br />:'8 ~'t:~~~ ~RegL<tTor
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<br />r,:;lg.::::~ .j', .':."",1 WARNING
<br />... II . .. ~ '\\\' \, ,''- .,
<br />t-I ~ ~ l:.. ,.' :':':'The p,enalty for,knowlngly making a false statement in this form can be 2.10 years in
<br />=- 0 ::-' ..... lC . ",,,;.' .,~rlson'and a flne of up to $5,000, (Article 4477c, Revised Civil Statutes of Texas)
<br />
<br />i: Ei"'~ ~ vs.~~~. Rfv~ liBO TellS Department 01 Health _ BUREAU OF VITAL STATISTICS
<br />.. =- ~ - ~ ~ ~ CERTIF1EJl. CAUSE OF DEATH t.. i: - ~
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