DEATH CERTIFICATE: Everet Clay; Beaver co., Utah

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State Board of Health File No.: 47
Stamped File No.: 0400047

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

Full name of Deceased: Everet Clay
Former or Usual Residence: 
Sex: male
Color: white
Date of Birth: 
Age: 7y 8m 20d
Single, Married, Widowed, Divorced: single
Birthplace: Summit co., Utah
Name of Father, Birthplace: J. W. Clay, Lancashire, England
Maiden Name of Mother, Birthplace: Elizabeth Harris, Wales

Occupation: 
Informant: J. W. Clay
Address: Beaver City

Place of Burial: Beaver City
Date of Burial: 1 Jan 1905
Undertaker: Jos. Ash
Address: Beaver

Medical Certificate of Death
Date of Death: 30 Dec 1904
Time: 12 noon
Chief cause: typhoid fever
Where contracted: Beaver
Duration: 22 days
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: I. E. Huffman, M.D.
Date: 30 Dec 1904
Address: Beaver