State of Illinois Certificate of Stillbirth
County Clerk's Record
Registered No. 4
Registration Dist. No. 411, Primary Dist. No. 3288

Place of Stillbirth:
County of Jefferson, Mt. Vernon City, 714 Perkins St.

Name of Child:  Infant of Lon Grigsby
Sex of Child:  Male
Legitimate?:  Yes
Date of Stillbirth:  April 11, 1933

FATHER:
Full Name:  Lon Grigsby
Residence:  Sullivan, Illinois
Color:  White
Age at Last Birthday:  65
Birthplace:  Unknown
Occupation:  Truckfarmer

MOTHER:
Full Maiden Name:  Hazel McNew
Residence:  Mt. Vernon, Illinois
Color:  White
Age at Last Birthday:  30
Birthplace:  East St. Louis, MO  *See Note
Occupation:  Housekeeper
Number of Children of This Mother born alive and now living: 1, born alive
but now dead: 0, stillborn: 1

Informant:  Hazel Grigsby, Mt. Vernon, Illinois

CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE:
"I hereby certify that I attended the birth of this child, which was BORN
DEAD April 11, 1933, ___(left blank)m.  Period of uterogestation _(left
blank)_.  Cause of Stillbirth:  Unknown.  Signature of attendant:  J E
Dixon,  Address:  Mt. Vernon, Telephone:  606"

CERTIFICATE OF UNDERTAKER
Place of Burial Cremation or Removal:  County Farm
Date:  April 12, 1933
Undertaker:  W. B. Myers, Myers Funeral Service
Address of Undertaker:  Mt. Vernon, Ill
Date filed:  4, 13, 1933
Registrar:  W. F. Carroll, Mt. Vernon, Ill 


*NOTE*  Birthplace of mother is incorrect.  Her birth and death certificates both
state place of birth was Jefferson County, Illinois.