Bennett, Iva Lee [Broadway]-Death Certificate - Bryan County, Oklahoma

Submitted by:  Sandra Haley <bsjhaley@mchsi.com>  13 Nov 2005
Return to Bryan County Archives:
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Surnames: Broadway
Classification: Query

Originally posted at:
http://boards.ancestry.com/mbexec/msg/rw/xZB.2ACI/1784

Standard Certificate of Death 
Department of Commerce Bureau of the Census State File No. 458, Registrar's No. 170 State of Oklahoma 09836

1.Place of Death 
a.) County: Custer
b.) City or town: Clinton, Oklahoma
c.) Name of Hospital or Institution: Western Okla. T. B. Sanitarium

2. Usual Residence of Deceased:
a.) State Oklahoma b.) County: Comanche c.) City or Town Caddo
d.) Street No. -
e.) Citizen of foreign country? No

3. (a) Bennett Iva Lee
3. (b) veteran -   3 (c) Social Security -  

4. Female   5. Race: White   6. (a) Married

6. (b)Husband: Luther Asbury Bennett
6. (c) Age of husband

7. B.D. 9-13-1905
8. Age:  35 yrs 9 months 5 days
9. Birthplace: Caddo Oklahoma
10. Usual Occupation: Housewife
11. Industry or business -

{12. Father: Andrew Broadway
{13. Birthplace Texas

{14. Mother, maiden: Laura last name not on Death Certificate {15. Birthplace: Oklahoma

16. (a) Informant's signature: Hospital Records (b) Address: Clinton Oklahoma

17. (a) Removal from hospital date thereof 6-20-1941 (b) Place of Burial Cache Oklahoma
She was embalmed, by Eegin Kern

18. (a) Funeral Director Cache Funeral Home (b) Address Cache, Oklahoma

19. (a) date received local registrar: 6-20-1941  (b) Registrar's Signature: Grace G Owens

MEDICAL CERTIFICATION
20. Date of Death: Month 6 Day 18 year 1941 Hour 2 p.m. minute 35 21. I hereby certify that I attened the deceased from April 4 1940 to 6-18 1941 that last saw her alive on the date and hour stated above Immedicate cause of death Pulmonary Tuberculosis duration 1 year?
Due to 013 B
Other conditions Laryngitis plus (spelling hard to read) Irendons?
Jelerad Rurln? Clinton Oklahoma 6-18-1941
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