How long Resident in the state. | - Place of Death
- Cause of Death
| - Complication
- Duration of Complication
- Duration of Disease
|
11 mos 7 days | - Liberty Mo
- Pneumonia
| - convulsions
- 22 days
- 6 hours
|
- Place of Burial
- Date of Burial
| - Name of Undertaker
- Place of Business
| Name and Residence of Physician Returning Certificate |
- Liberty Mo
- March 2, 1884
| - J.L. Riley
- Liberty
| E H. Miller MD Liberty Mo |