Missouri Death Certificates 1910 - 1960, Missouri State Board of Health, Missouri State Archives (Lawson). Dade Co., MO. -- City: Rural Walnut Grove -- Reg. District #93 -- File #26506 -- Reg. #77 -- Length of Stay: 51 yrs. -- Full Name of Hospital or Institution: Walnut Grove (Polk Twp. Dade County) -- Usual Residence Where Decease Lived: Walnut Grove, Rural Polk Township, Dade County, Mo. -- Margaret Jane Smith -- Date of Death: July 13, 1949 Date of Birth: April 22, 1859 -- Age: 90 yrs. 2 mos. 21 days -- Housewife -- Kind of Industry or Business: Home Keeper -- Birthplace: Dade County, Mo.
Name of Father: Thomas Grisham -- Maiden Name of Mother: Mary Brown. Name of Husband: Henry G. Smith -- Was Deceased.
Informant's Signature: Mrs. Perry Hurst -- Address: Walnut Grove, Mo.
Certification: DISEASE OR CONDITION DIRECTLY LEADING TO DEATH: Arteriosclerosis,Chronic Cholecystitis.
CONDITIONS: Senility.
"I hereby certify that I attended the deceased from Jan. 5, 1949 to Jul. 10, 1949, that I last saw the deceased alive on Jul. 13, 1949, and that death occurred at 6:05 A. M., from the causes and on the date state above". Signature: J. Barber, M.D. -- Address: Walnut Grove, Mo. -- Date Signed: July 14, 1949
Burial Date: July 15, 1949 Mo. -- Date Rec'd By Local Registrar: July 17, 1949 -- Registrar's Signature: Geo. L. Wier -- Funeral Director's Signature: Gene A. Brim - Address: Walnut Grove, MO. *Note: 1.) James Grisham's middle name was Perry; 2.) Cholecystitis is inflammation of the gall bladder.
Above info supplied by Jan Lawson.
Missouri Death Certificates 1910 - 1960, Missouri State Board of Health, Missouri State Archives (Lawson). Dade Co., MO. -- City: Rural Walnut Grove -- Reg. District #93 -- File #26506 -- Reg. #77 -- Length of Stay: 51 yrs. -- Full Name of Hospital or Institution: Walnut Grove (Polk Twp. Dade County) -- Usual Residence Where Decease Lived: Walnut Grove, Rural Polk Township, Dade County, Mo. -- Margaret Jane Smith -- Date of Death: July 13, 1949 Date of Birth: April 22, 1859 -- Age: 90 yrs. 2 mos. 21 days -- Housewife -- Kind of Industry or Business: Home Keeper -- Birthplace: Dade County, Mo.
Name of Father: Thomas Grisham -- Maiden Name of Mother: Mary Brown. Name of Husband: Henry G. Smith -- Was Deceased.
Informant's Signature: Mrs. Perry Hurst -- Address: Walnut Grove, Mo.
Certification: DISEASE OR CONDITION DIRECTLY LEADING TO DEATH: Arteriosclerosis,Chronic Cholecystitis.
CONDITIONS: Senility.
"I hereby certify that I attended the deceased from Jan. 5, 1949 to Jul. 10, 1949, that I last saw the deceased alive on Jul. 13, 1949, and that death occurred at 6:05 A. M., from the causes and on the date state above". Signature: J. Barber, M.D. -- Address: Walnut Grove, Mo. -- Date Signed: July 14, 1949
Burial Date: July 15, 1949 Mo. -- Date Rec'd By Local Registrar: July 17, 1949 -- Registrar's Signature: Geo. L. Wier -- Funeral Director's Signature: Gene A. Brim - Address: Walnut Grove, MO. *Note: 1.) James Grisham's middle name was Perry; 2.) Cholecystitis is inflammation of the gall bladder.
Above info supplied by Jan Lawson.
Family Members
Sponsored by Ancestry
Advertisement
Records on Ancestry
Advertisement