Form C. STATE OF MAINE. CERTIFICATE OF DEATH Name, John M. Rich Place of Death, Treasuret No. Street Ward, Village, How long a resident, Previous residence, life Date of Death: Year, 1919, Month, 3 Day, 5 Age: Years, 65 Months, 11 Days, Place of Birth, Tremont Date of Birth: Year, 1853 Month, 4 Day, 5 Sex, m Color, white Married, Single, Widowed. of Divorced Occupation, mainner Name of Father, Clias Rich Maiden Name of Mother, Emily Rich Birthplace of Father, Placentia pth Birthplace of Mother, Tremont Occupation of Father, marrina Deceased was wife of Widow of {Over]