Missouri Birth & Death Records Database

 

CountyRoll NumberPageNumber
ClayC 180410119
Date of Report
(Month/Day/Year)
  1. Name
  2. Sex
  3. Color
  1. Age (Year/Month/Day)
  2. Occupation
July 24, 1884
  1. unknown
  2. Male
  3. Black
  1. 10-13 yrs
  2. know
Date of Death
(Month/Day/Year AM or PM)		Single, Married,
Widower or Widow
  1. Nationality
  2. Place of Birth
Single
  1. don't know
  2. don't know
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. don't know
  2. drowning in the Mo River
  3. instant death
  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
  1. left body with Marcus Rord and J. Smith July 26, 1
  1. Ford and Smith
  2. Liberty Landing Clay Co Mo
A. B. Bush Coroner 6 miles West 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.