Missouri Birth & Death Records Database

 

CountyRoll NumberPageNumber
ClayC 180412
Date of Report
(Month/Day/Year)
  1. Name
  2. Sex
  3. Color
  1. Age (Year/Month/Day)
  2. Occupation
Oct 8, 1883
  1. Jane Holloway
  2. Female
  3. Black
  1. 55 yrs 6 mos 2 days
Date of Death
(Month/Day/Year AM or PM)		Single, Married,
Widower or Widow
  1. Nationality
  2. Place of Birth
Sept 28, 1883 7 AMMarried
How long Resident in the state.
  1. Place of Death
  2. Cause of Death
  1. Complication
  2. Duration of Complication
  3. Duration of Disease
30
  1. Liberty Mo
  2. Heart disease supposed ???
  1. Her death was instantanious
  3. Don't know
  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
  1. Liberty Mo
  2. Sept 29, 1883
  1. Jas. L. Riley
  2. Liberty Mo
J M Allen MD Liberty Mo J M Allen
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.