Permanent Record of Deaths

County

Roll Number

Page

Number

Chariton

C 1629

259

 

 

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

Feb 25, 1885
  1. Thomas Hart
  2. Sex - Male
    Color - White
  1. 75yr 10m 21d
  2. Farmer

 

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

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

Feb 15, 1885

Married
  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

54yr
  1. Salisbury Twp
  2. Pneumonia
  1.  
  2.  
  3. 3-4 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. Richardson Graveyard
  2. Feb 17, 1885
  1. Lagrass
  2. Salisbury

T. P. Perkinson, MD; Chariton Co., Mo.

 

 

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