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<br />� . 6 OESCR�9E HOW iNJURY OECURREQ ANO IF TqA P qT N INJUpV TI# TY9E(5) Ol
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<br />� Records Services Cheyenne, Wyoming.
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<br />I � � STATE�FILENUMBER �
<br />1( �'� �ATEOf'DEATHIMdDpy/Yr)(SG40MOnihl..
<br />�„� E_,. UC�BER 22. 2004
<br />kY � 'b. D�TE OF 91RTN lMol[1aYLYr1:�
<br />� JANUARY 31 1914
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