[FORM NO. 8.] APPLICATION FOR A CERTIFICATE OF DEATH. I respectfully ask for a transcript from the Coroner of.. relating to the death of That it appears from the Record of Marriages, in the County of. ..County, .186 .days, .months,. .days, .day of.. .186 That it appears from the Record of Births in the County of. .186.. [FORM NO. 11.] CERTIFICATE OF CAUSE OF DEATH. I hereby certify that I attended (Name of the deceased,).. 1. Aged..... .years,. 2. Occupation,.. ..(Single) (Married) (Colored) [Cross out the words not requied in 3. Term of residence in this City or County, [And how long in the United States, if of 4. That I last saw h....on the.... 5. That....died the....day of.. 6. And that the CAUSE of h....death was this line.] foreign birth, .186.., at No... .186.. .St., Ward. APPLICATION FOR A TRANSIT PERMIT. Permission is desired to pass through the City, the remains of Residence in City. Of Deaths occuring in. County, for the year ending December 31st, 186 Name. Months. Undertaker. Color. Occupation. Physician. Years Months. Days. |