Menard COUNTY Illinois - Miscellaneous Death records - death1.txt ********************************************************************************* Copyright. All rights reserved. http://www.usgwarchives.net/copyright.htm This file was contributed for use in the USGenWeb Archives by: © Matthew Ferricks ********************************************************************************* Certificate and Record of Death Full name: Seede Balster Sex: female Color: white Married Birthplace: Amt Aurich, Ger. Date of birth: Jan. 11, 1844 Age 68 years 7 months 5 days Died on the 18 Day of June 1912 at about 11:30 P.M. Place of death: Petersburg County of Menard How long in state: 50 years How long in U.S. if foreign born: 50 years Name of father: Luken Birthplace of father: Aurich Maiden name of mother: A. Paben Birthplace of mother: Aurich Informant: Henry Balster Address: Petersburg Ill. Place of burial: Rose Hill Cemetery Date of burial: June 21 hour 2 P.M. Certificate of Death Length of residence in city or town where death occurred: 72 yrs. How long in U.S. if of foreign birth: 72 yrs. Full name: Henry Balster Residence: Petersburg, 2 Ward Sex: Male Color: White Widowed Widower of Sada Lukins Date of birth: Jan. 19, 1841 Age: 91 years 8 months 10 days Retired Farmer Date deceased last worked at this occupation: Mar. 1, 1900 Birthplace: not known, Germany Informant; Henry Balster, Jr. Place of burial: Rosehill, Petersburg, Menard Co., Ill. Date: Oct. 1, 1932 Date of death: Sept. 29, 1932 I hereby certify, that I attended deceased from Sept. 1, 1932 to Sept. 29, 1932. I last saw him alive on Sept. 29, 1932; death is said to have occurred on the date stated above, at 9 a.m. The principal cause of death and related causes of importance were as follows: Cerebral apoplexy. Other contributory causes of importance; Chronic Bright’s Disease. T.M. Scott, M.D. Physician’s Certificate of Death Name, William W. Workman Sex, Male Color, White Age, 28 years Occupation, Laborer Date of death, Sept. 11, 1895 hour 1 P.M., Single Nationality and place where born, American born How long resident in this state, full life Place of death, near Petersburg, Ills. Cause of death, had his neck broken by falling back into the well Place and date of burial, Rose Hill Cemetery Name and place of undertaker: J.W. (illegible) Petersburg, Ills. Dated at September 12th 1895 G.L. Clary, Coroner Certificate of Death Full name: Henry Baum Sex: Male Color: White Married Husband of: Alice Baum Age: 63 years 7 months 23 days Occupation of deceased: farmer Birthplace: do not know, Illinois Name of father: George Baum Birthplace of father: Germany Maiden name of mother: Margaret Kale Birthplace of mother: Germany Informant: John Rhodes Address: Petersburg, Ill. Date of death: March 2, 1921 I hereby certify, that I attended deceased from Feb. 28, 1921, to March 2, 1921 that I last saw him alive on March 2, 1921 and that death occurred on the date stated above, at 2 P.M. The cause of death was as follows: fatty diginnation of heart. Contributory: obesity. F.F. Hill, M.D. Place of burial: Rose Hill Cemetery Date of burial: Mar 4, 1921 Certificate and Record of Death Full name: George Baum Sex: White Color: Male Married Birthplace: Germany Date of birth: Jan. 1, 1833 Age: 83 years 28 days Died on the 28 day of June 1914 at about 1:15 A.M. Place of death: near Tice county of Menard How long in state: 59 years How long in U.S. if foreign born: 61 years Name of father: not known Birthplace of father: Germany Maiden name of mother: not known Birthplace of mother: Germany Informant: Mrs. Geo. Baum Place of burial: Rose Hill Cemetery Date of burial: Jan. 30, hour 12:30 P.M. Physician’s certificate of Cause of Death: I hereby certify that I attended deceased from May 10, 1913 to Jan. 28, 1914 that I last saw him alive on the 25 day of Jan. 1914 that death occurred, on date stated above, at about 1:15 o’clock A.M., and that to the best of my knowledge and belief the cause of his death was as hereunto written: cause of death: Chronic Bright’s Disease. Duration: 9 months. Witness my hand this 28 day of Jan. 1914. H.E. Wilkins, M.D. Physician’s Certificate of Death Name: Caroline Truesdale Sex: female Color: white Age: 17 years 7 months 7 days Date of death: Feb. 7 hour 4 A.M. Married Nationality and place where born: American born of German parents near Jacksonville How long resident of this state: all her life. Place of death: about 4 ½ miles east of Petersburg in country Cause of death: valvular disease of heart – valves involved similunary Complictions: child birth followed by typho-malarial fever Duration of disease: probably six months but only under my treatment about a month Place and date of burial: Rose Hill Cemetery Feb. 8th, 1878 Dated at: Petersburg Feb. 8, 1878 C.E. Elliot, M.D. Certificate and Record of Death Full name: Amanda Workman Sex: female Color: White Married Birthplace: Ill. Date of birth: 1834 Age: 79 years 8 months 26 days Died on the 19 day of April 1914 Place of death: Tice county of Menard How long in state: entire life Birthplace of father: Ill. Place of burial: Petersburg, Ill. Date of Burial: April 21, 1914 Medical Certificate of Cause of Death: I hereby certify that I attended deceased from April 10, 1914 to April 19, 1914 that I last saw her alive on the 15 day of April, 1914 that death occurred, on date stated above, at about 4 o’clock P.M. and that to the best of my knowledge and belief the cause of her death was as hereunder written: cause of death: Senility. Duration: 3 wk. Witness my hand this 1st day of May 1914 F.F Hill, M.D. Certificate of Death Full name of deceased: John William Baum Sex: male Color: white Age: 29 years 28 months (should read 11 months) Occupation: farmer, single Died on the 28 day of January 1905, at about 10: 45 A.M. Place of death: Menard Co., Ills Place of burial: Rose Hill Cemetery Date of burial: Jan. 30, 1905 Cause of death: Pneumonia. Duration: 7 days I hereby certify, that the above stated personal particulars are true to the best of my knowledge and believe, and that the cause of death in the above stated name and described deceased was as above written by me. Witness my hand, this 29 day of Jan. 1905. H.E. Wilkins, M.D. Standard Certificate of Death Full name: Evaline C. Snell Sex: female Color: white Married Date of birth: March 25, 1842 Age: 75 yrs. 20 ds. Birthplace: Ohio Name of father: William Moorhead Birthplace of father: Ohio Maiden name of mother: Margaret Arthur Birthplace of mother: Ohio Informant: Mrs. Nellie Balster Address: Petersburg, Ill. Filed: Apr. 18, 1917 J.A. Rhodes Date of death: April 15, 1917 I hereby certify, that I held an inquest and that death occurred, on the date stated above, at 6:46 P.M.. The cause of death was as follows: natural causes, probably heart disease. H.E. Wilkins Place of burial: Rose Hill Date of burial: April 17, 1917 Certificate of Death Full name: Arphad Snell Sex: M Color: W Widowed Date of birth: Feb. 16, 1841 Age: 83 yrs. 6 mos. 2 ds. Retired Birthplace: Williamsburg, Ohio Name of father: Daniel M. Snell Birthplace of father: Ohio Maiden name of mother: Jane Moorhead Birthplace of mother: Ohio Informant: Chas. Harley (should be Hartley) Medical Certificate of Death - Date of death: Aug. 18, 1924 I hereby certify, that I attended deceased from June 14, 1924 to July 16, 1924 that I last saw him alive Aug. 11, 1924 and that death occurred, on the date stated above, at 6 P.M. The cause of death was as follows: Sinile Debility. Contributory: Prostatis Loren E. Orr, M.D. Place of burial: Rose Hill Cemetery Date of burial: Aug. 20, 1924 Physician’s Certificate of Death Name: William Adams Sex: male Age: 64 years 25 days Occupation: farmer Date of death: April 10, 1886 hour 10 A.M. Widower Nationality and place where born: American, Kentucky How long resident in this state: twenty five years, about Place of death: Sweetwater, Ill. Cause of death: Rheumatism Complications: Endocarditis Duration of disease: unknown for some years Place and date of burial: Sweet Water Cemetery, April 12 Dated at Sweet Water, Ill, April 17, 1886 E.M. Mortcott(?), M.D. Standard Certificate of Death Full name: Minerva Bennett Residence No.: Athens, Ills. Length of residence in city or town where death occurred: 23 yrs. Sex: female Color: white Divorced Wife of Samuel Bennett Date of birth: Feb. 28, 1887 Age: 41 years 9 months 15 days Birthplace: Grange City, Ky. Name of father: John A. Powell Birthplace of father: Ky Maiden name of mother: Adaline Adams Birthplace of mother: Ky Informant: Adeline Warmotti(?) P.O. address: Tallula, Ills. Medical Certificate of Death: Date of death: Dec. 13th, 1928 I hereby certify that I attended deceased from Dec. 6th, 1928 to Dec. 13th, 1928 that I saw her alive on Dec. 12th, 1928 and that death occurred, on the date stated above, at 2 A.M. The cause of death was as follows: Acute Bronchitis. Duration: 7 ds. F.F. Hill Place of burial: Hall Date: Dec. 14, 1928 Standard Certificate of Death Full name: Vina Hughes Length of residence in city or town where death occurred: 33 yrs. Sex: female Color: white Married Wife of Michael Hughes Date of birth: March 19, 1878 Age: 50 years 9 months 13 days Birthplace: Fleming Co., Ky Name of father: information could not be obtained Maiden name of mother: Kate Adams Birthplace of mother: Fleming Co., Ky Informant: Lee Hughes P.O. address: Greenview, Ill. Medical Certificate of Death: Date of death: Jan. 2, 1929 I hereby certify, that I attended deceased from Dec. 22, 1928 to Jan. 2, 1929 that I last saw her alive on Jan. 2, 1929 and that death occurred, on the date stated above, at 6:45 P.M. The cause of death was as follows: Chronic Myocarditis. Duration: 20 yrs. Contributory: Lobar pneumonia. Duration: 6 ds. Loren E. Orr, M.D. Place of burial: Sugar Grove Date: Jan. 4, 1929 Standard Certificate of Death Full name: Adaline Powell Sex: female Color: white Married Date of birth: October 31, 1858 Age: 59 yrs. 9 mos. 29 ds. Birthplace: Kentucky Name of father: Art Adams Birthplace of father: Kentucky (born in Fleming county) Maiden name of mother: Cela McKiney (her name was Celia Ann McKinney) Birthplace of mother: Kentucky Informant: Wm. Powell Address: Athens, Ill. Medical Certificate of Death: Date of death: Aug. 30, 1918 I hereby certify, that I attended deceased from July 28, 1918 to Aug. 30, 1918, and that death occurred, on the date stated above, at 10:30 P.M. The cause of death was as follows: Chronic Endocarditis. Duration: 1 yrs. F.F Hill Place of burial: Hall Cemetery, Athens, Ill. Date of burial: Sept. 1, 1918 Certificate of Death Full name of deceased: Louis Schmidt Sex: male Color: white Age: 83 years 8 months 19 days Widower Place of birth: Germany Died on the 13th day of October 1907, at about 7 P.M. Place of death: six miles south of Petersburg Place of burial: Rose Hill Date of burial: Oct. 16, 1907 Cause of death: general debility resulting from cirrhosis of liver & kidneys. Duration: 2 years I hereby certify, that the above stated personal particulars are true to the best of my knowledge and belief, and that the cause of death of the above named and described deceased was as above written by me. Witness my hand, this 11th day of November 1907. Herman Rothert State Board of Health - Return of Death to County Clerk Name: Rachael E. White Sex: female Color: white Age: 69 years 11 moths 22 days Date of death: Feb. 19, 1894 Widow Nationality and place of birth: American, Tenn. How long resident in this state: 62 yrs. Place of death: Athens Prec. Cause of death: abdominal tumor Duration of disease: unknown Place of burial: Lebanon Date of burial: Feb. 21st, 1894 State Board of Health - Return of Death to County Clerk Name: Robert F. White Sex: male Color: white Age: 74 years 10months 22 days Occupation: Farmer Date of death: Dec. 7th, 1893 Married Nationality and place of birth: American, Illinois How long resident in this state: lifetime Place of death: Athens Prec. Cause of death: La Grippe – temperature 106 Complications: valvular disease of heart Duration of disease: four days Place of burial: Lebanon Date of burial: Dec. 10th, 1893 Certificate of Death Full name: Emer White Sex: female Color: white Widowed Birth date of deceased: August 4, 1865 Age: 82 years 4 months 12 days Birthplace; Athens, Ill. Name of father: Madison Derry (his name was James Madison Derry) Birthplace of father: Harper’s Ferry, W.Va. Maiden name of mother: Martha Pollock Birthplace of mother: unknown, Ohio (she was born in Jefferson county) Informant: Robert F. White P.O. address: Petersburg, Ill. Place of burial: Lebanon Date: Dec. 21, 1947 Medical Certificate of Death: Date of death: month 12 day 18 year 1947 hour 10:05 P.M. I hereby certify that I attended the deceased from October 20, 1947 to 12-18, 1947 that I saw her alive on December 18, 1947 and that death occurred on the date and hour stated above. Immediate cause of death: Chronic Myocarditis. O.L. Zells Certificate of Death Full name of deceased: James M. Derry Sex: male Color: white Age: 82 years 5 months 4 days Place of birth: Virginia Lived in Illinois: 55 years Occupation: retired farmer Married Died on the 23 day of Feb. 1905, at about 5 A.M. Place of death: Petersburg, Ill. Place of burial: Rose Hill Date of burial: Feb. 25, 1905 Cause of death: progressive paralysis. Duration: 4 years I hereby certify that the above stated personal particulars are true to the best of my knowledge and belief, and that the cause of death of the above named and described deceased was as above written by me. H.P. Moulton Certificate of Death Full name: Martha Jane Derry Sex: female Color: white Widowed Date of birth: July 19th, 1841 Age: 75 yrs. 5 mos. 26 da. Birthplace: Ohio Name of father: John Pollock Birthplace of father: Penn. Maiden name of mother: Druzella Barker (her name was Druzilla Barcus) Birthplace of mother: Ohio Informant: Charles Derry Address: Greenview, Ill. Medical Certificate of death: Date of death: Jan. 15th, 1917 I hereby certify, that I attended deceased from May 1st, 1916 to Jan. 15th, 1917, that I last saw her alive on Jan. 14th, 1917, and that death occurred, on the date stated above, at 3:45 A.M. The cause of death was as follows: carcinoma of liver and intestines. Place of burial: Rose Hill Date of burial: Jan. 17th, 1917 Medical Certificate of Death Name of deceased: Edith Essie Frerichs Date of death: May 2, 1959 Sex: female Race: White Married Date of birth: July 8, 1889 Age: 69 Father’s full name: John White Mother’s full maiden name: Emma Derry (her name was Emer Derry) Informant: Fred Frerichs, husband Address: Athens, Illinois Cause of death: Arterio-Sclerotic heart dis. Bronchial Asthma I hereby certify that I attended the deceased from Nov. 1st, 1958, to May 2nd, 1959, that I last saw the deceased alive on Apr. 5, 1959, and death occurred at 6 A.M. from the causes and on the date stated above. T.F. Hill Burial place: Hall Cemetery Certificate of Death Full name: Thomas Frerichs Sex: male Color: white Married Husband of Johanna Frerichs Date of birth: Feb. 7, 1867 Age: 70 years 3 months 23 days Birthplace: Germany Father’s name: Conrad Frerichs Birthplace of father: Germany (he was born in the town of Strackholt) Maiden name of mother: Ustena unknown (her name was Justine Bolema) Birthplace of mother: Germany (she was born in the town of Ayenwolde) Informant: Fred Frerichs P.O. address: Petersburg, Ill. Place of burial: Rose Hill Date: June 1, 1937 Medical Certificate of Death: Date of death: May 30, 1937 I hereby certify, that I attended deceased from April 10, 1937, to May 30, 1937. I last saw him alive on May 29, 1937; death is said to have occurred on the date stated above, at 6 A.M. Cause of death: cardiac asthma, mitral insufficiency. Date of onset: 1 yr. Contributory cause of death: arterio sclerosis. Date of onset: 2 yrs. T.M. Scott Medical Certificate of Death Name of deceased: Hannah Frerichs Date of death: Dec. 17, 1954 Sex: female Color: white Widowed Date of birth: April 18, 1864 Age: 90 Birthplace: Germany (she was born in the town of Wurthfleth) Father’s name: Louis Schmidt Mother’s maiden name: Dena Brummerloh Informant: Carl L. Frerichs Address: Greenview, Ill. Cause of death: cancer of colon. Interval between onset and death: 11 months. Others significant conditions: metastasis of cancer to liver. Interval between onset and death: 2 months. I hereby certify that I attended the deceased from Jan. 21, 1954, to Dec. 17, 1954, that I last saw the deceased alive on Dec. 17, 1954, and that death occurred at 3:30 P.M., from the causes and on the date stated above. S. Paulauski, M.D. Burial place: Rose Hill Date: Dec. 20, 1954 Medical Certificate of Death Name of deceased: Anna Elizabeth Adams Date of death: December 27, 1961 Sex: female Color: white Married Date of birth: July 19, 1891 Age: 70 Birthplace: Colfax, Kentucky Father's full name: William Rogers Mother's full maiden name: Sarah Estill Informant signature: Ralph Adams Address: Whittier, California Cause of death: acute hemorrhagic pancreatitis. Interval between onset and death: 2 days. Other significant conditions: scleroderma I hereby certify that I attended the deceased from 11/4, 1961, to 12/27, 1961, that I last saw the deceased alive on 12/27, 1961, and death occurred at 7:20 P.M., from the causes and on the date stated above. Neale Barned, M.D. Burial place: Hall Cemetery Date: 12/30/1961