IMAGE EVALUATION TEST TARGET (MT-3) Y / o V ^ /,„. ^w ^ «^ 1.0 I.I 1.25 •■'" U WUu 1.4 IIM 1.6 V] & /a W itr«Ct. LONOON, ONT. March, 15th, 18HC. O. Residence Port Perry Peterboro Ottawa Cause of Death. Cerebritis Syncope Tumour Date of Joining. Death. July 3 73 Feb. 8 '86 June 12 '83 Feb. 12 '86 Oct. 28 '73 Feb. 14 '86 taths having been reported, and passed the Board, lue within 30 days from date hereof on your jents, or to H, dfiL- BAXTER, Socrotaiy. p. O. Drawer 514, London, Ontario. r To your Credit Previously DUE Within 30 days. To your Credit in advance at date.