Osage County, Oklahoma, Vital Records:  Clara Ann Rollo Death Certificate

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Email:  VONBIER@aol.com
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Oklahoma State Board of Health
Bureau of Vital Statistics
Oklahoma City, Okla.
Register No. 447
County:  Osage
City:  Shidler

2. FULL NAME of decedent:  Clara Ann Rollo

PERSONAL AND STATISTICAL PARTICULARS
3. Sex:  F
4. Color or Race:  white
5. Single, Married, Widowed or Divorced:  Married
6. DATE OF BIRTH:  6/10/1891
7. AGE:  39 yrs. 2 mos. 9 days
8. OCCUPATION:  wife
9. BIRTH PLACE: Okla
10. NAME OF FATHER:  Geo. Hood
11. BIRTHPLACE OF FATHER:  ?
12. MAIDEN NAME OF MOTHER:  Francis Peugh
13. BIRTH PLACE OF MOTHER:  Mo
14. The above is true to the best of my knowledge
Informant:  E. A. Berghoefer
Address:  Shidler
15. Filed 8/20  1930
C L Shufelat, Registrar

MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH:  8/19  1930
17. I, HEREBY CERTIFY that I attended deceased
From ___ to ____
That I saw her death
And that death occurred on the date state above at
10:30 p.m.
THE CAUSE OF DEATH, Was as follows:
Thrombus Coronary Artery
Signed:  C. H. Guild M. D., 
8/20  1930   Address:  Shidler
18. LENGTH OF RESIDENCE
(This section left blank.)
19. PLACE OF BURIAL OR REMOVAL:  Pawhuska
Date of Burial:  8/21  1930
20. UNDERTAKER:  C. L. Shufelat
Address:  Shidler