Death Certificate: William Windom, 1916: Marion County, Oregon ******************************************************************************* USGENWEB ARCHIVES(tm) NOTICE: All documents placed in the USGenWeb Archives remain the property of the contributors, who retain publication rights in accordance with US Copyright Laws and Regulations. In keeping with our policy of providing free information on the Internet, these documents may be used by anyone for their personal research. They may be used by non-commercial entities so long as all notices and submitter information is included. These electronic pages may NOT be reproduced in any format for profit. Any other use, including copying files to other sites, requires permission from the contributors PRIOR to uploading to the other sites. The submitter has given permission to the USGenWeb Archives to store the file permanently for free access. http://www.usgwarchives.net/or/orfiles.htm ******************************************************************************** Transcribed and formatted for use in USGenWeb Archives by:DAS, Volunteer 0001015 May 9, 2003 ********************************************************************************* Surnames: Windom, Miles, Bryant, Bates William Windom Oregon State Board of Health, Bureau of Vital Statistics STANDARD CERTIFICATE OF DEATH Registered No. 226 (Stamped No. 296) 1 PLACE OF DEATH: County: Marion City: Salem (State Hospital, 36 Ward) 2 FULL NAME: William Windom PERSONAL AND STATISTICAL PARTICULARS: 3 Sex: Male 4 Color or Race: White 5 Single, Married, Widowed, or Divorced: Single 6 Date of Birth: 1845 7 Age: 71 years 8 Occupation: Farmer 9 Birthplace: Missouri 10 Name of Father: -- 11 Birthplace of Father: -- 12 Maiden Name of Mother: -- 13 Birthplace of Mother: -- 14 The above true to the best of my knowledge (Informant) State Hospital Records (Address) Salem Ore 15 Filed 6/4/1916 O.B. Miles, Registrar W.L. Bryant, Deputy MEDICAL CERTIFICATE OF DEATH: 16 Date of Death: June 3rd, 1916 17 I HEREBY CERTIFY, That I attended deceased from June 23 [sic], 1916, to June 3rd, 1916, that I last saw him alive on June 3rd, 1916, and that death occurred, on the date stated above, at 5:45 pm. The CAUSE OF DEATH was as follows: Carcinoma of face. (Signed) C.E. Bates M.D. June 4, 1916 (Address) Salem Ore 18 Length of Residence (for Hospitals, Institutions, Transients, or Recent Residents): At place of death: 42 yrs, 4 mos 5 ds In the state: 44 yrs Where was the disease contracted, if not at place of death? Linn Co. Former or usual residence: -- 19 Place of Burial or Removal: Cremated by State Date of Burial: -- Undertaker: -- Address: -- ----------------------------