Form C 1920 STATE OF MAINE CERTIFICATE OF DEATH Name - Jod Place of Death Himoon No Warl Village - How long a resident Previous residence - Date of Death: Year Day 21 Age: Place of Birth. Termant Years Months Days. 4 have Date of Birth: Year 1924 Month Just Day. 21 Sex. H Color W Married, Single Widowed or Divorced. } I Occupation / Name of Father Earnest Joya Birthplace Maiden Name of Father of Mother Jamen Birthplace of Mother TremosN Occupation of Father : Snheman Deceased was wife of - - Widow of (Over