Missouri Digital Heritage :: Collections :: Birth & Death Records Database :: Death Record Detail

Missouri Birth & Death Records Database

Permanent Record of Deaths

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County Roll Number Page Number
Miller C 4465 3

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
1883
  1. Smith, Mrs. - -
  2. Sex - Female
    Color - White
  1. 32 yrs
  2. House Keeper

Date of Death
(Month/Day/Year AM or PM) 		Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
Sept. 29, 1883 Married

How long Resident in the state. 1. Place of Death
2. Cause of Death		 1. Complication
2. Duration of Complication
3. Duration of Disease
  1. Eldon, Miller Co. Mo.
  2. Consumption and Uervous Prostration
  1. Ulcer of stomach Enlargement of spleen Jaundice
  3. about 1 year

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
 Name and Residence
of Physician
Returning Certificate
  1. Jacks?ns Burial Ground
J. B. McGee M. D.
Tuscumbia,Mo

NOTE
 

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Due to possible errors or discrepancies in this abstract it is recommended that researchers request a print copy. To request a copy of this record, please print a copy of this page and mail it to the Missouri State Archives, PO Box 1747, 600 W. Main Street,  Jefferson City, MO  65101 with a check or money order for $1.00 made payable to the Missouri State Archives.  Please include a #10 business size, stamped, self-addressed envelope with each request.  Please submit one photocopy request at a time.