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
Bollinger C 753 29

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
July 11 1887
  1. John Black
  2. Sex - Male
    Color - White
  1. 27 yrs
  2. Engineer

Date of Death
(Month/Day/Year AM or PM)
Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
June 30 1887 3am Married
  1. USA
  2. Franklin Co Illinois

How long Resident in the state. 1. Place of Death
2. Cause of Death
1. Complication
2. Duration of Complication
3. Duration of Disease
4 y
  1. Liberty Twp No 1
  2. acute Phthisis
  1. about 5 months

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
  1. Kings Chapel
  2. July 1 1887
  1. Barney Corey
  2. Liberty Twp No1
J.C. Cubbage Bollinger 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.