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Show \ 1.1 ) 1ll 'u L '1' 1' 1.11.1'1 ) 1I :1 :I !lj l l l \1\ 11,11 I , icuIa!' klllll of I"I Ul'1c UOllU, n:J CJJL; llll! '-' l' (type of) , miner, bookkeeper, etc. -(b) Industry or business in v,hich work was done, n ~ r ai l way , mine (kind of), balik, et c . llousowl1'o Cenditien for which perfermed \'las there an autepsy? no If death was due to. external ca u :JC:; (c) Date deceased la st worked at ' this occupation (month and year) 1936. (d) Total time (years) spent in this occupation (vielence) fill in also. the fellowi ng : Accident, Date Douelas (Sta te o.r County) Isle of Man suicide, ~r hemicide? ef injury 10 nrnTHPLACE (City or Tovm) ! 11 NAME OF FilTHill John Jalles 12 BIRTHPLACE OF FATHER (State 0.1' Ceunty) 13 I1ilI~EN Isle of Man NAME OF MOTHER Elizabeth Halls 14 BIRTH?LACE OF MOTHER Isle ef Man (State er Ceunty 15 INFORMAl'IT (Signature) Mary Alice Par,rish Address Centerville, Utlah 16 BURIAL, CREMATION, OR REMOVAL Ple,ce Centerville Date June 13, 1937 17 UNDERTAKER ' Addre:ss Unien Mertuary Beuntiful 18 FILED June 13, 1937 Vlhel'e did injury eccur? (Specify city er town, county and State) Specify whether injury e ccur re:d in industry, in heme, er in public place : Manner ef injury Nature ef injury Vias desease er injury ill way relat ed to. eccupatien ef deceased? If so., specify REGISTERED NU1rn::H 6 M. D. B. L. Kesler (Signed) L. A. Dalrymple Registrar. June 9 1937 Addr,ess Beuntiful, Utah Sta te ef Utah, Ceunty ef Salt Lake I, \Vm. M. McKay, M. D., State Health Cemmissiener and State Registrar ef Vi tal Statistics, de hereby certify tha,t the wi thin and feregeing record ef death is a true and cerrr;Jct cepy ef the e~'iginal certificate ef death ef ELIZABETH MULES WHITAKER new en file in the effice of the Utah State Beard ef Health at Salt Lake i City, Utah, and made ef recerd in s a id effice. In Witness \'H1ereef, I have hereunto. set my hand and affixed the offic ial seal ef the Utah State Board ef Health this SIXTH day ef APRIL A, D. 1942 EM Wm. M. McKao' State Heal th Cemmissiener end State Registrar ef Vital Statistic s . Abstracted Recerded January 22, 1944J at 12:05 P. M. /71_ - ;1 e - 3tf> - C( |
