Date of Report (Month/Day/Year) | - Name
- Sex
- Color
| - Age (Year/Month/Day)
- Occupation
|
Feby 22, 1884 | - Jackson Julia A.
- Female
- White
| - 38 yr
- Farmer Wife
|
How long Resident in the state. | - Place of Death
- Cause of Death
| - Complication
- Duration of Complication
- Duration of Disease
|
21 y | - Corn[ean] Grundy Co. Mo
- Gastralgia
| - ?
- 6 weeks
|
- Place of Burial
- Date of Burial
| - Name of Undertaker
- Place of Business
| Name and Residence of Physician Returning Certificate |
- North Union Cemetery
- Jany 10/84
| - Y[????]
- Trenton, Mo
| J. E. Lei?? MD, ?, Mo |