Streeter, Jennie Augusta Forra
I SWAWN or N36W YORK4if
CO
Name of'Sown t
tVillaget and County f s .
i
YAT
...
(£fated, -1 !
' The Certificate of Beath g been furnished to me, as required by t Lams of this State,per fission
is hereby given f he,Buriad .Age .G
c i €C1it�orTd taa } a ,.,,.,. ��
a*7o di d at, th Con ty o
`j on. / .190 t Fcause of death being.Q.:� . ., >«>a ..
Place of L'ural, �,
° U,ndertaker or person I
in charge of Burial, {Signed ..
E Residence .
.., .... ........ ..... .. .. .........
€C}ffie3aa title.}i