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:> =. :. PERSONAL PARTICULARS (To M filled in by F.m.r~1 Dir«:lor)

~ i i; ;,u:;-uA-L'"jfdID~NcE lb. COUNTY .C' fjJ,.vl~c8'~;lrk' OR . : •. I",sloe-efT"':' :d. STREET AND HOUSE NUMBER ~;!~ AII . · ....to... '},6U''lork H.Y. rcc""ll I 1~lest72Strcet , _ , I l-Jt.IIT$OFl >r~= ! Bvu ON _l!r U,'M'.;iii't1\LS'l.\TUS ,Ch.ck 011.' !>. CITIZEN OF WHAT COUNTRY 10. NAME OF SURVIVING spouse (If wile. "i~. ,.,.~." ".....1 J-c~' ~u.· lq~",.'~·a"'ed Great Bri~.Lu Z o!' ~') M.'".d 0,10,".,.,,,, Yoko OnoJJ ~.s~. Ce".. ::I [;w.<lO...." .OOlyo,c'"

tico= __ " ' Ut,TEOF (Monl'" IDay' IV.." 12' AGEAT IfUNOER1Yu,~ flinT" OF LAST mn\. nay,

~ 0 ~! u;;cr. IU;t".__Oc c.ober 9, 1940 BIRTHDAY 40 : -!: : ~o , ~Tun.~-," ' co<' ", ' . 1.1. lISlI;'L OCCU~AT'O'" liCind ol ...o,k done d ..,in. "",.. of lb. KINO OF BUSINESS \'- .~ •••

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! Yn'r:,o O~'lO l.ennon I • iCe l 1 .Iest 72 5tr~et NYCI -~-Ir.."·;:·:T;F.-of CIi,.~"TEn v on eli.,: ""A ,,:,c.~'( ; .... LOC·' nON (CiIY. Town. SI.n. an.' co·."try) lc. DATE 0" ,Il '''' ' ..\I:-Zi;~-· L " 'rds1ev , ~I.V. I cnEMA,tONIernclif! Cre:ll"ltor:r ... J.t I. I D 10 19 Q O

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·(HE CITY OF NEW YOnrBUR~AU OF VITAL RECORDS

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Autopsyfiles.org - John Winston Ono Lennon Death Certificate