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I hereby certify tha; I attended di!Ceasedfromh ....gj'~~JR'ld-- 190...ut",.J~2..! ...I.J!.~I90u""that I last saw.~-alive on the ....___/~.: .......uuu.uu"dayof .... ~/fi.'?d. ..---------I90 ... u •• , tltat.::,...., ....diedon the .........../IL.L ..................day if~ ...L.P~ ....I90....---, about..~.o'clock~or P .• ~f., andtlzat to best if my knowledge and b~lief, the cause oj: .... .death was as hereunder written. I Duration of Disease...~~~:~::~i;::;;:~1!~~ ..~mm ....I.m ...... mmm

Sanitary ob"':£';~;~;£;;~%;;7~;i1C;;; ...•...•••....•..

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PIa<' of Bndal,~mmm 4'p. '7) fI],A~ Oat< of Bndal, ~~ ...... L ....L............ mm ... m..

undertaker£,L., .' '5t" .m-:J1, RESID:ii;. ~ vi:Residence, ,~ ___r:." ...___ ,.'~ ," ___ .~ .. """."",.".,u_' ui.Year.

Month.Day.

Place of Death. ~~ ~~t

Date of Death. 1f'9dA~J;-.lLAge, in years,

How longmos. and days. 6D J Resident here.

It in an Insti-Sex. ~tution give

name and1oca Hon.

Color •

White.How long an

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Indian------- --words not JaI'QaesoPreviousI

applicable.)~Residence.I

!1trSc",--dJt~!Single, ~larried, ..~!r-/!~.-L

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IName.Divorced. ," '

Occupation. ~~.

Father's' [State or Country.)

Birthplace.

------------Birthplace. JJ4JI~ti;;~

Mother's,fl(Name.

I How long in I

:\Iother'sI -----' U. S. if foreignBirthplace.I born. I

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countYofu~~---'-;1.J;TATE OF NEW YORK-BuREAU OF VITAL STATIST~ST~wnof,.J~ Certificate and Record of Death Registered No.

:i::;.~:..::,':,::::':::::·:,:::::·.::::·.:'::::::'::::::: '''2.2'6.uu ..uu..... ...~?k /h ~Full Name of Deceased,..u.. ,."" ""u ".,. ,..Lu , __u""hu __uu """ __U"u,,, ,,"u"u. hhhhu""u.h(If an infant not named give fa.mily name.)

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and honorably

of the rebelliC'n. That the

born ... ,"n'" •••••• __.•••• n •••••• ,

born ,

born , 18 : , at ...........................•.........................................

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BOllnty paid '~106; dlle $. _ . 1OU

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)lu3ters, a:; the ca.--iefna>· b'.', wil! ('(It:n:~'r,i~nb~)lh

nnu-.ot serv\(',e. Till:Y \\ i;\ t._ 1;~:',1~:'(.ti.l :.; \:" l':jt"th~·

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\Vhcre born

Muster and Descriptive Roll of a Detach­ment of U. S. Vols. forwarded

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-f / / , )/ ~I ,____fIy.,C/Ll.j'~L '.LLj~LL LL~i_J~_£ .

Appears with rank OL ncC/ __I.l .__on

A .• '~)( ,gce .. _/ __y rs;

-When elllisted //[L:/.<- ...:,~/---.., 1t5Gt .!- /

\V hcre cnlisteelh" ._.c~.-<':"c':.:h(:h!._.. .L .•.. nw. /'

For what period enlisted .. ·,_n . Lnu_.yr.nrs.

Eyes __u.L-~:.,::c ; hair uubj{""m m, /)/ . ,'--- /.ComplexJ(Ill.~~;;~:7'(' ... -un; helght.,-'.L_Jt.._.£2_.tn.

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" hClIlllllsterc<l lll L.:n"-::~~~__~/ __" 18~.\Vhcre mustered in __u_L'.£,c>·.L.__L.:'L.Ll._;d-:.:.'/.1

,'-"0{ ~ b>- /Bounty paid $.__..J.J~__~oo; due $_."';'~n_loo

Where ereditcd~c {i:,~{ f./!,A:.(;-:L __.h/-L(...£_"_•. ~'. I.J "" -«. ('::'r/ r / /

Company to which assign:'(] mm_m.nnnm m

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~g~~~z..o;t~t2.a/u ~G(-4~~du.7~-d:./~1:':'~~did'''~Book mark:

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for the.,~!iL Hcg't N. Y. I~fu~h:y. Hall dated(y /

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Appea!'1:i with nmk of._~~_,_

ltIuster and Descriptive Roll of a Detach­

ment of U. S. V0t, ,~~rwardedf()!, thes -!7'/:._]{eg'i N, Y.lnfafftry. h~oll dated

/{Z:t:--LL--£_~;? PI.. , N, y.,?);-I. /, IHGf':

Where GOJ'Jl -~c--<./'-- ;;~4>:-?"-/A,\ In ,- '?(-' ,'" . \ . f " ~o A: •• __ .• :-"U /_) 1-", Oe<:up.IIOIl ,0('< G-. /-.v 7-",,-cL ..

\II hen unlisted r;~z..<t'?'~ ,.7 , ] 86 y.

Where (:1l1j:-;led ~~_/t:..<._- .. /Y';;;; Iii'o!' wirat pm'ivcl enlisted __. . / . years.

Eycs..-~~~.a&D?1; hail' - 4/={~,. I' rd,. ~L ]' I t rY'f'L ./ .vOlllp eXlOll~. <.......-&/(_; ICLg \ .. ~,.. ""' llJ.

When mustered in,....~~L.'~. ~7»'18~\Vhel'l) lllllstered in

(339)

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GENERAL AFFIDAVIT.

~tatBofJ.~o/~'-,a"·~·~~~In the m~erOf~etJ' .~ __.~.~ ~ ...............................•...

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ON THI~ ~ day. of. : A. D .. r1DV; perso~al\Y appear~d. before me

a~ ".v:.~ In and for the aforesaId County ~ authorIzed to admlllister oaths,

. '-d" ~ .. ,ged; .. ~" .. yem, a ,,,;dent of .. tJP..~ :111 the County of ~"r>' and State 0f. .~--R.MJ .. : N~ .whose Post Office address is .. r:f??~ ~~ ..~ .. ~ .

~.d~ .../,~~ ..aged %0. years, a resid~nt of /6.~'7'~ .111 the County of M7?-;<....-~·~d .. ··· .and State 01. .. J~~ .\yhose Post Office address IS .•... , r:1t/C)Y-~a. , .well k nOIVn to me to be reputable and ertBtled td credit. and who, being duly sworn, declared in rela-

tion to aforesaid case as foJlows: .' . ~...d! ~ ~.~' ..~ ~~ ~ ~'"/ Q [:--IOTE.-. ants should state how they gain a knowledge of ~he facts -0 w;: tes~ ( ~

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(If Affiants sign by mark. two persons who c.J.n write sign here.]

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