Document MMODzw6Q2kY0oX2mNmXMzqqMV

PLAINTIFF'S EXHIBIT Unumu Division I:. si; KAN Cii CO.'.i FA. < i' GROUP LIFE CLAIMS mtUlT Kl'MtM'K NAME OF C.ROUr . AIM No. 4-3 C2 Serial No. Date iKCrKKKO SOT Johnson's Co. Color Age Cause or Deatii OK Disability 43 . 272 P,/?4 3/30 34 pul- 'F.Jl, -- IHantii 1-i ty -k? TVfS \( ~33~ 561- ...74a_ 721... V U. 6 /jO 17/30 !\a tfcp 7/13 PET7O 49 5ft 55 2Q rirtTriVir." 1 l!r*nn^n T m -H -aa f-i OH-- I'.Tt. nf lun(*K +-1 " VuL... l/j^ ??0._ 1003 r--------------------------- 10 63 ... . 1/34 . t. .3/34 .. lluO --12/34. CQ._ _PUlaoJ1.J.Ira at dc_naphrita (>?. Il-iYirw/* nf Tl. Inn- 6-5- _.7_ Anglh3- -AH itg _}Rq | I If t N rorm Act.470 A*ur. tn m iv ! < Code No. Amount | 353 mnn 'ill 3 non 5 JL jt" 1/17.. . mAn . 7I_ ... 1 mu) 112- -2000------------------ 1 3nr.n .vr:Wanf priAQ Al 7r>nn eo 1 a rn 93 . jtynn -93- ..j<nnn -- i i i ,4 i 1 i ! -j/jO 3/29 11/2? ji \ i. ; .. 1 12/29 -- \ i .j 12/29 3/30 4/30 i 5/30 s ij i i i j _______,9/iQ .19/30 i i 1 1 1? Clninnt Hapartnci fron n/"jC)/3f t,n 4 An /t.c -----------------A O irj Uwy - ---- ~~ 52 Ilro'-C'in ti.iiiic 66 Tuaior oi' livor 21 Tuberculosis 19 Pneumonia 21 Acciuont 26 Poisoning 23 .'lit by car 31 Pneunonis 25 Cause not 6 reified _Z4_. Caneor 46 TB. Pul PE'.DIOG - DISABILITY 110 lu00 41 1000 91 1000 104 500 l'/J 1000 1?2 190 1000 l'.UO 104 1000 209 1000 41 1000 51 1000 1000 ____________________ ?<r;/ 16/J5................. --------------------------------- ------- ----------------------------------------