Registration of Deaths
[???] June
County Eau Claire
Date July 8 1907
1. Full name of deceased,
2. Maiden name (if wife or widow),
3. Color and sex,
4. Race,
5. Occupation of deceased,
6. Age (years, months, and days),
7. Name of father,
8. Birthplace of father,
9. Name of mother,
10. Birthplace of mother,
11. Birthplace of deceased,
12. Date of birth of deceased,
13. Condition (single, married, widowed,
or divorced),
14. Name of wife or husband of deceased,
15. Date of death,
16. Cause of death, {Primary.
Secondary.
17. Duration of disease,
18. Place of death,
19. Residence at time of death,
20. Was deceased ever a U. S. soldier or sailor?
21. Name of physician, coroner or justice,
22. Residence of such person,
23. Name of undertaker or other person conduct-
ing burial,
24. No. and date of burial permit,
25. Place of burial,
26. Date of certificate,
27. Date of registration,
28. Other important facts not related,
|
51
00261
Harriett E. Tryon
Harriett E. Travis
White- Female
American
-
82 yrs 8 mo. 19 da
Silas Travis
York State
Flora Travis
York State
June 3 - 1824
Widowed
-
Feb 22 - 1907
Chronic Bronchitis
Dilated heart & debility[?]
Six years
Eau Claire
Eau Claire
No
E.S. Hayes
-
R. H. Stokes
-
Eau Claire
May 1 - 1907
May 21 - 1907
J.F. Farr, H.O.
66[?]
|
[Wisconsin law prohibits
public display of
Wisconsin vital records.]
|