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It has not been edited and may therefore contain several errors.

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Wife?s Name
Residences Birth Date _
?x 11 Marriage_____
Married.
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. Place .Place
Death Date_'SJz)*^1^ Place
Where Buried_____________
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His Father?s Name ^)tU^ru<y^.
Death Date_ 8I&1I7W	__Place
Where Buried__
Her Father?s Name
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His Mother?s Maiden Name y^??c<^
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PLEASE INCLUDE MIdSe NAMES IF KNOWN. WRITE ]
Her Mother?s Maiden Name
DAY. MONTH (ABBREVIATED), YEAR ON DATES.
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