Missouri Birth & Death Records Database

 

CountyRoll NumberPageNumber
ClayC 1804554
Date of Report
(Month/Day/Year)
  1. Name
  2. Sex
  3. Color
  1. Age (Year/Month/Day)
  2. Occupation
Feb 6, 1884
  1. Slaugher Seals
  2. Male
  3. Black
  1. 31 yrs 6 mos 4 days
  2. laundry Man?
Date of Death
(Month/Day/Year AM or PM)		Single, Married,
Widower or Widow
  1. Nationality
  2. Place of Birth
Jan 9, 1884Married
  1. American African ?
  2. Clay Co Mo
How long Resident in the state.
  1. Place of Death
  2. Cause of Death
  1. Complication
  2. Duration of Complication
  3. Duration of Disease
  1. Liberty Mo
  2. Phines Pulmon?
  1. Hereditay ? Known for he was a family slave about
  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. Jan 10, 1884
  1. Jas L Riley
  2. Liberty Mo
J. L March MD Liberty Mo
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.