How long Resident in the state. | - Place of Death
- Cause of Death
| - Complication
- Duration of Complication
- Duration of Disease
|
37 | - Webster County, MO
- Pneumonia
| - Pluricy
- 8 Days
- 8 Days
|
- Place of Burial
- Date of Burial
| - Name of Undertaker
- Place of Business
| Name and Residence of Physician Returning Certificate |
- Whittenbury
|
| Dr. D.A. Williams, Niangua |