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Form 2015-20M-701044(68)[[seal]]346 APPLICATION NO.------- OFFICE OF CHIEF MEDICAL MEDICAL EXAMINER Borough of Man APPLICATION FOR COPIES OF RECORDS ON FILE Date 11-8-74 Name of Deceased Doris Yllman Date of Death 6/28/74 Place of Death Man Number of copies requested: 2.001 Inquisition ........Hospital Report 4.001 2pp Autopsy Report, Etc. ........Police Report 2.001 Chemical ...... Serological Report 2.001 Identification 1.50 [[strikethrough]]Others (Specify) [[/strikethrough]] N.O.D. $11.50 Signature.... ( ) Mail Address..... ( ) Will call City..... Zone No....State..... Not to be filled in by applicant Case No. M74-5297 Borough Man Cash Receipt No.... Date Fee Paid S. Thomas Signature of Clerk