DEATH CERTIFICATE: Sula Baker; Beaver co., Utah

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State Board of Health File No.: 19
Stamped File No.: 0400020

Place of Death
County of: Beaver
City, Town or Village: Beaver City
Street and No.: 
If in Hospital or Institution, give name: 

Full name of Deceased: Sula Baker
Former or Usual Residence: Beaver City
Sex: female
Color: white
Date of Birth: 13 Mar 1903
Age: 1y 3m 6d
Single, Married, Widowed, Divorced: single
Birthplace: Beaver County
Name of Father, Birthplace: Wm. Baker, Beaver Co., Utah
Maiden Name of Mother, Birthplace: Doritha Ipsom, Beaver Co., Utah

Occupation: 
Informant: Wm. Baker
Address: Beaver City

Place of Burial: Beaver City
Date of Burial: 21 Jun 1904
Undertaker: Joseph Ash
Address: Beaver City

Medical Certificate of Death
Date of Death: 19 Jun 1904
Time: 11 pm
Chief cause: congestion of brain
Where contracted: Beaver County
Duration: 7 days
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: John Ward Chrsitian, M.D.
Date: 21 Jun 1904
Address: Beaver