Johnson County, Missouri death certificate of John Jefferson Warner

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Date: Sun, 26 Jan 2003
From: <Darrell Warner> 
http://www.genrecords.net/emailregistry/vols/00001.html#0000008
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MISSOURI DEATH CERTIFICATE
1. Place of death
  a. County: Johnson
  b. Township: Kingsville
  c. City: nothing listed
  d. Registration district number: 428
  e. Primary registration district number: 5583
  f. File number: 25368
  g. Registered number: 9
2. Full name: John Jefferson Warner
  a. residence, number, street, and warD: nothing listed
  b. length of residence in city or town where death occurred: nothing listed
  c. How long in US if of foreign birth: nothing listed
  d. If nonresident give city, town or state: nothing listed
3. Sex: male
4. Color or race: white
5. Single, married, widowed or divorced (write word): Widower
5a. If married, widowed or divorced list husband or wife: Mary Warner deceased
6. Date of birth: February 29, 1836
7. Age 83 years 5 months 12 days
8. Occupation of deceased
  a. trade profession or particular kind of work: retired farmer
  b. general nature of industry, business or establishment in which 
employed (or employer): nothing listed
  c. name of employer: nothing listed
9. Birthplace
  a. city or town: Owingsville
  b. state or country: Kentucky
10. Name of father: William Warner
11. Birthplace of father
  a. city or town: Owingsville
  b. state or country: Kentucky
12. Maiden name of mother: Mary Triplett
13. Birthplace of mother
  a. town or city: Culpepper Court House
  b. state or country: Virginia
14. Informant
  a. name: Mrs. H. A. Brierly
  b. address: Peculiar, Missouri
15. Date filed August 13, 1919
  a. Registrar: J. L. Angell (best guess)
16. Date of death: August 12, 1919
17a. I hereby certify, that I attended the deceased from January 1917 
to July 20, 1919, that I last saw him alive on July 20, 1919, and that 
death occurred, on the date stated above at 6:00 PM
  b. The cause of death was as follows: senility duration 3 years
  c. Contributory causes: makurd heart action (best guess)
18. where was the disease contracted
  a. if not at place of death: nothing listed
  b. did an operation precede death: nothing listed
  c. date of: nothing listed
  d. was there an autopsy: nothing listed
  e. what test conformed diagnosis: nothing listed
  f. signed: H. A. Brierly MD
  g. date signed: August 13, 1919
  h. address: Peculiar, Missouri
19. Place of burial, cremation or removal:
  a. place: Strasburg Cemetery
  b. date of burial: August 13, 1919
20. Undertaker
  a. name: J. W. Goodman
  b. address: Holden Missouri