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
Gentry C 8988 4 44

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
11/13/1883
  1. Mason, Henry E---y
  2. Sex - Male
    Color - White
  1. 2y 3m 9d

Date of Death
(Month/Day/Year AM or PM)
Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
11/18/1883
  1. Gentry 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
2
  1. Gentry Co., Mo.
  2. Diptheria asthma from general symptons
  1. Hemmorage from nose throat an passages
  2. 24 hours
  3. 7 days

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
  1. Fair View
  2. 11/13/1883
  1. G. R. Weller
Wm. Sturdley, Berlin, 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.