| Title |
Death Certificate: Daugherty, Margaret - 1911 |
| Short Title |
Death Certificate: Daugherty, Margaret - 1911 |
| Publisher |
Nebraska State Dept of Health, Bureau of Vital Statistics |
| Call Number |
No. 4224 |
| Repository |
Nebraska Department of HHS Finance & Support |
| Source ID |
S35 |
| Text |
STATE OF NEBRASKA
Certificate of Death
Register Nos (blank) Local (blank) State 4224 Date May 11
4224
D-263
PLACE OF DEATH
County of Nemaha
Township of No. 5
or Village of Brownville
or City of (blank) (No. (blank) Ward)
FULL NAME Mrs. Margret (John) Daugherty
----------
PERSONAL AND STATISTICAL PARTICULARS
SEX Female
COLOR White
DATE OF BIRTH (Month) Jan (Day) 31 (Year) 1835
AGE 76 years 3 months 7 days
SINGLE, MARRIED, WIDOWED OR DIVORCED married
BIRTHPLACE (State or Country): East Brook - Pa
NAME OF FATHER Thomas Fisher
BIRTHPLACE OF FATHER (State or Country) Westmoreland Co Pa
MAIDEN NAME OF MOTHER Polly Kells
BIRTHPLACE OF MOTHER (State or Country) Lancaster Co Pa
OCCUPATION Housewife
----------
The above stated personal particulars are true to the best of my knowledge and belief
(Informant) Thomas Daugherty
(Address) Auburn
----------
Filed: May 8 1911 D H McLaughlin Local Registrar
----------
MEDICAL CERTIFICATE OF DEATH
DATE OF DEATH (Month) May (Day) 7 (Year) 1911
I HEREBY CERTIFY, that I attended deceased from Dec 20 1909 to May 7 1911 that I last saw her alive on May 7 1911 and that death occurred on the date stated above at five thirty Pm.
The CAUSE OF DEATH was as follows: Senility
one year 5 months (Duration) (blank) Days
CONTRIBUTORY (blank) (Duration) (blank) Days
Signed F . W. (?) Blumer
May 7 1911 (Address) Brownville Neb
----------
SPECIAL INFORMATION only for Hospitals, Institutions, Transients, or Recent Residence
Former or Usual Residence (blank)
How long at Place of Death (blank) Days
----------
PLACE OF BURIAL OR INTERNMENT Brownville
Date of Burial May 9 1911
UNDERTAKER H D McLaughlin
ADDRESS Brownville |
| Linked to (1) |
KELLS Mary |
Fisher Family Genealogy