Certificate of Death |
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Scioto Twp ., Jackson, Ohio |
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*0903 |
Full Name: |
Dova Beatrice Fout |
Registration Dist. No.: |
4962 |
Residence: |
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Primary Reg.: Dist. No.: |
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Sex: |
Female |
Registered No. |
7 |
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Color or Race: |
caucasican |
Date of Death: |
Sep. 24, 1914 |
| S/M/W/D: |
single |
Time of Death: |
10:00 am |
| Spouse: |
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Served in Military: |
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| Date of Birth: |
Aug. 21, 1892 |
Institution: |
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| Age: |
22y 1m 3d |
Cause of death: |
Typhoid Fever |
| Trade/Profession: |
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| Industry: |
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| Date last worked: |
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Contributory Causes: |
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| Birthplace City: |
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| Birthplace Co./St: |
Ohio |
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| Father: |
Ezra Fout |
Born: |
Ohio |
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| Mother: |
Margaret Keller |
Born: |
Ohio |
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| Informant: |
Ezra Fout |
Address: |
Beaver, O |
| Burial, Cremation or Removal: |
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Date of Burial |
Set. 26, 1914 |
| Burial Location |
Mountain Ridge |
Address: |
Beaver, Ohio |
| Undertaker: |
Gosiavis |
Address: |
Beaver, Ohio |
| Source: State of Ohio Department of Health, Division of Vital Statistics |
| NOTE: Returned cert. says: The injury was sustained in a slate fall when employed in a coal mine. |
| Contributed by: |
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