Missouri Birth & Death Records Database

 

CountyRoll NumberPageNumber
JacksonC 195106824238
Date of Report
(Month/Day/Year)
  1. Name
  2. Sex
  3. Color
  1. Age (Year/Month/Day)
  2. Occupation
  1. Potten Jean Gauntier
  2. M
  3. W
  1. 1
Date of Death
(Month/Day/Year AM or PM)		Single, Married,
Widower or Widow
  1. Nationality
  2. Place of Birth
12/01/1906S
  1. KC.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. 3000 Prospect
  2. Inanition
  1. Place of Burial
  2. Date of Burial
  1. Name of Undertaker
  2. Place of Business
Name and Residence
of Physician
Returning Certificate
Henry Croskey
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.