Permanent Record of Deaths

County

Roll Number

Page

Number

Chariton

C 1629

 

7

 

Date of Report
(Month/Day/Year)
  1. Name
  2. Sex and Color
  1. Age (Year/Month/Day)
  2. Occupation

Oct. 18, 1883
  1. Martha J. Tillotson
  2. Sex - Female
    Color - White
  1. 82yr 5mo
  2. Farmer

 

Date of Death
(Month/Day/Year AM or PM)

Single, Married,
Widower or Widow
  1. Nationality
  2. Where Born

Oct 11, 1883

Widow
  1. U.S.
  2. Virginia

 

How long Resident in the state.

1. Place of Death
2. Cause of Death

1. Complication
2. Duration of Complication
3. Duration of Disease

40 yrs
  1. Salisbury Twp.
  2. Lung congestion
  1. Debility
  2.  
  3. 1 week

 

  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business

Name and Residence
of Physician
Returning Certificate
  1. residence (Chariton County)
  2. Oct 12, 1883
  1.  
  2.  


T. P. Parkenson, Salisbury, Mo.

 

 

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