.
STATE:
Missouri
File Number:
40110
Registered #1254

CERTIFICATE OF DEATH

MISSOURI STATE BOARD OF HEALTH


Record transcribed from original recorded public records to avoid violation of direct reproduction/copyright laws.
This is not an official copy, but research of official documents are listed here for the purpose of family research.
This page will give the researcher a reference number and the location of where to find this official document.


Document obtained from Erlene Dudley
Transcribed by Kevin Everingham


DECEASED



DECEASED NAME:
Ethel L. Everingham
SEX
F
DATE OF DEATH:
Dec 13, 1916
PLACE OF BIRTH:
MO
Place of Death:
St. Joseph, MO
AGE
8hrs
Date of Birth:
Dec 12, 1916
OCCUPATION:
n/a
City of DEATH:
St. Joseph
County of DEATH:
Buchanan
STATUS:
single
Time of DEATH:
4:00 A.M.
Color or Race:
White
ADDRESS:
(can't read it)
Registrar & Date of Registration:
D.O. Kelly (Dec 14, 1916)
PARENTS

FATHER:
N.G. Everingham (b.New York)
MOTHER:
Josephine Vest (b.MO)
Informant

Informant:
Thos Rock
Address:
916 Fred Ave.
CAUSE



IMMEDIATE CAUSE:
8 month gestation
INTERVAL:
-
CAUSE:
and not fully developed
INTERVAL:
-
CONTRIBUTORY:
(can't read it)
PHYSICIAN:
Wm. M. Campbell M.D.
BURIAL

All Burial Information:
Ashland Cemetery (Dec 13, 1916)



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