Information on this page may not be
used for personal or financial gain.
It is to be used for research only. Thank you.
Please understand that some of the handwriting was faded, incomplete, and poorly written,
therefore, some errors in transcribing may have occurred.
Register of Death Information
(1) Date of Death (2) Name of Decedent (3) Place of Birth (4) Age,
Years, Months, Days (5) Sex (6) Color
(7) State, Married, Single, Widowed (8) Occupation (9) Cause of Death (10) Place of Death
(11) Place of Burial (12) Informant, Doctor, Midwife, or Head of Family (13) No. of Certificate