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S to H-30) What was the first name of the deceased? What was the month and year of death? What was the age in years at death? What is the sex of the deceased? M Male F Female Write the month and year of death. Dot the appropriate box. Y Yes N No Dot the appropriate box. Y Month N If YES, how many? If the deceased was a woman under 50 years, did (the person) die while pregnant or within six weeks after delivery? Y Yes Dot the appropriate N No box. Dot the appropriate box. D.

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