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
Andrew C 93 4 50

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
Mar 5,1884
  1. James Earl Anderson
  2. Sex - Male
    Color - White
  1. 1 y, 8 m,15 d
  2. blank

Date of Death
(Month/Day/Year AM or PM)
Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
Jan 24,1884 2 PM blank
  1. American
  2. Fillmore,Andrew Co,Mo

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 y, 8 m,or 15 m
  1. Bolckow, Andrew Co,Mo
  2. Capillary Bronchitis
  1. Congestion of Brain
  2. Twenty four hours
  3. 5 d

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
  1. Fillmore,Andrew Co,MO
  2. Jan 25th
  1. Floyd & Wood
  2. Bolckow, Mo
W.E.Burlch MD - Bolckow, Andrew Co,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.