Full Name of Deceased |
George
Smith |
Color |
white |
Sex |
Male |
Age |
5 years |
Name of Father of Deceased |
|
Name of Mother of Deceased |
|
Occupation |
Laborer on R & R |
Place of Birth |
U. S. |
Name of Wife of Deceased |
|
Name of Husband of Deceased |
|
Date of Birth |
1872 |
Date of Death |
June 28, 1877 |
Cause of Death |
Scarlet fever |
Name of place, town or township,
and county in which person died |
Peshtigo, Wis. |
Name and location of burial
ground in which interned |
Peshtigo, Wis. |
Name of person returning certificate |
L. J. Smith |
Residence of such person |
Peshtigo |
Date of Certificate |
June 28, 1877 |
Date of Registration |
Oct. 13, 1877 |
Other Information |
No Attendance |
|
Full Name of Deceased |
Albertina
Smith |
Color |
White |
Sex |
Female |
Age |
1 year |
Name of Father of Deceased |
|
Name of Mother of Deceased |
|
Occupation |
|
Place of Birth |
U. S. |
Name of Wife of Deceased |
|
Name of Husband of Deceased |
|
Date of Birth |
June 1876 |
Date of Death |
Feb. 23, 1877 |
Cause of Death |
Scarlet fever |
Name of place, town or township,
and county in which person died |
Peshtigo, Wis. |
Name and location of burial
ground in which interned |
Peshtigo, Wis. |
Name of person returning certificate |
L. J. Smith |
Residence of such person |
Peshtigo, Wis. |
Date of Certificate |
June 28, 1877 |
Date of Registration |
Oct. 13, 1877 |
Other Information |
No Medical Attendance |
|
|