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CERTIFICATION OF VITAL RECORD
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4. SOCIAL SECURITY NUMBER
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DEPARTMENT OF HEALTH
STATE OF WYOMING
DEPARTMENT OF HEALTH 1 1
CERTIFICATE OF DEATH
DATE ISSUED:
DUE TO (Oft AS A CONSEQUENCE OFF
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FEBRUARY 15, 192; 11111
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ST/GE FIE NUMBER
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Lucinda McCaff y
Deputy State Re lgtrar 11)
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