Personal and Statistical Particulars

Sex:   Male                    Color:  White

Date of Birth:  March 28, 1845

Age:  65 years, 9 month, 9 days

Married

Birthplace:  New York City

Name of Father:  Edward McGraw

Birthplace of Father:  Ireland

Mother's Maiden Name:  Mary Adams

Birthplace:  Ireland

Occupation:  Plummer

The above stated personal particulars are true to the best of my knowledge and belief:

Informant:  H. G. Kurtz

       1136 P. Street

Medical Certificate of Death

Date Of Death:  January 6, 1911

I hereby certify, that I saw him alive on January 5, 1911 and that death occurred on

the date stated above, at 9 A.M.

The Cause of Death was as follows:

Valvular Heart Trouble

Signed:  H. G. Kurtz,  M.D.

January 6, 1911

1136 P Street