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MISSOURI STATE BOARD OF HEALTH
Bureau of Vital Statistics Certificate of Death
Place of Death: Dallas County
Township: Wilson
Registration District No: 247
File No: 25718
Primary Registration District No: 5343
Registered No: 14
Full Name: Essie Ruby Williams
Sex: Female
Color or Race: White
Martial Status: Single
Date of Birth: Oct. 10, 1914 (1913)
Age: 10 months, 20 days
Birthplace: Dallas Co, Mo.
Name of Father: Green B. Williams
Birthplace of Father: Mo
Maiden Name of Mother: Arminda Slack
Birthplace of Mother: Mo
Date of Death: Aug. 30, 1914
I HEREBY CERTIFY, that I attended deceased from Aug 29, 1914, to Aug 29, 1914, that I last saw her alive on Aug 29, 1914, and that death occurred, on the date stated above, at 8 a.m.
The CAUSE OF DEATH* was as follows : Cholera
Duration: 2 1/2 days
Signed: H. Talbot M. D. Aug 30, 1914, Long Lane Mo
Informant: J. A. Slack, Long Lane, Mo
Place of Burial or Removal: Hill Cemetery
Date of Burial: Aug 31, 1914
Undertaker: Wilson & Newport, Buffalo, Mo
Filed : Aug 30, 1914
Registrar: H. Talbot
[Contributed by Debra Burgess]

 


 

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