Date of Report (Month/Day/Year) | - Name
- Sex
- Color
| - Age (Year/Month/Day)
- Occupation
|
June 15, 1886 | - Thornton, Geo, M. D.
- Male
- White
| - 40 yrs 3 mos 10 days
- Farmer
|
How long Resident in the state. | - Place of Death
- Cause of Death
| - Complication
- Duration of Complication
- Duration of Disease
|
2 yrs | - Glaze Township
- Epiliptic convulsions
| - Bronchial trouble
- 2 wks
- 24 yrs
|
- Place of Burial
- Date of Burial
| - Name of Undertaker
- Place of Business
| Name and Residence of Physician Returning Certificate |
- Branch Place, Camden Co, Mo
- May 11, 1886
| - T M Houston
- Glaze Township, Mo
| W S MillerBagnell, Mo |