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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 15

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation
May 29, 1884
  2. Sex -
    Color -
  1. 2d

Date of Death
(Month/Day/Year AM or PM) 		Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born
May 28, 1884 Single
  1. American
  2. Hill 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
life
  1. Hill Twp.
  2. ?????????????????
  3. 2 day

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
 Name and Residence
of Physician
Returning Certificate
  1. Bumer Cemt.
H. C. Beall; Coloma

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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