DEATH CERTIFICATE

12. Of Hispanic Origin?

13. Ever in U.S. Armed Forces?

16a. Place of Death

16c. Place of Death in City Limits?

18f. Residence Inside City Limits?

22a. Method of Disposition

1 + 4 =

Baton Rouge
225-778-1612

Port Allen
225-778-1612

Plaquemine
225-778-1612

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