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Trtifitatt FILED 19ftL. OCT 16 of State Cert phi came No. PM 2 29 J. NAME or Tvtnstril) OF DECEASED i!me. . First Name PRI “l later ................ MJ;JD;:N;;;;:;;. . l.w. HL if!.JJ.KG. ........................
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d t- 1 refers to the tax form used for reporting income tax returns.
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