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

Missouri State Archives
Missouri Birth & Death Records Database

Permanent Record of Deaths

County Roll Number Page Number
Carroll C 1368 4

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
Dec 26, 1883
  1. Monicle, Infant
  2. Sex - Male
    Color - White
  1. 1/2 hr

Date of Death
(Month/Day/Year AM or PM) 		Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
Dec 23, 1883
  1. England
  2. Ridge Twp.

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. Ridge Twp.
  2. Want of utero development

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
 Name and Residence
of Physician
Returning Certificate
  1. Bridge Cr.
  2. Dec 24, 1883
  1. L. French
  2. Ballsville
 R. K. Gibson; Hurricane Twp.

NOTE
 

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.
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