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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