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I HEREBY CERTIFY THAT the foregoing is a true and correct copy of the death record for the
decedent named in item 1 and that this record was established and filed in my office in accordance with the provisions of the Illinois Statutes relating to the registration of
births, stillbirths nnd deaths.
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date OCT 21 1985
______________________ signed ^
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At Cook County Department of Public Health Official Title Chief Deputy Registrar
1r'0n.S. Mavhr.xik I'ri--.-
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DANA-335