DEATH CERTIFICATE: Winnie Evans; Beaver co., Utah

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State Board of Health File No.: 
Stamped File No.: 0400009

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: Winnie Evans
Former or Usual Residence: Beaver
Sex: Female
Color: White
Date of Birth: 25 Jan 1904
Age: 1m 20d
Single, Married, Widowed, Divorced: single
Birthplace: Beaver
Name of Father, Birthplace: Riess Evans, Beaver
Maiden Name of Mother, Birthplace: Margaret Evans, Beaver

Occupation: infant
Informant: E. J. Limb
Address: Beaver

Place of Burial: Beaver
Date of Burial: 17 Mar 1904
Undertaker: 
Address: 

Medical Certificate of Death
Date of Death: 15 Mar 1904
Time: 7:25 pm
Chief cause: pneumonia
Where contracted: don't know
Duration: 
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: I. E. Huffman, M.D.
Date: 4 Mar 1904
Address: Beaver