Form C 1921 State of Maine CERTIFICATE OF DEATH Name will Nation Place of Death Tremont No Ward Village How long a resident 40 you Previous residence Date of Death: Year 192-Month / Day 6 Age: Years 68 Months Days Place of Birth morristown Date of Birth: Year 18.60 Month Day Married, Single Sex m Color X Widowed or Divorced. } Name Occupation of Father Bussion Nalas Maiden Name of Mother Julia Milis Birthplace of Father Phila Birthplace of Mother Prothand Occupation of Father Doctor Deceased was wife of Widow of (Over)