DEATH CERTIFICATE: Helen Marie Fennemore; Beaver co., Utah

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State Board of Health File No.: 41
Stamped File No.: 0400041

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: Helen Marie Fennemore
Former or Usual Residence: Beaver City
Sex: female
Color: white
Date of Birth: 3 Jul 1904
Age: 4m
Single, Married, Widowed, Divorced: infant
Birthplace: Beaver
Name of Father, Birthplace: A. H. Fennemore, Pennsylvania
Maiden Name of Mother, Birthplace: Idana Lochua, Utah

Occupation: 
Informant: A. H. Fennemore
Address: Beaver City

Place of Burial: Mount Olive
Date of Burial: 4 Dec 1904
Undertaker: 
Address: 

Medical Certificate of Death
Date of Death: 2 Dec 1904
Time: 10 pm
Chief cause: intussuception
Where contracted: Beaver
Duration: 1 day
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: I. E. Huffman, M.D.
Date: 3 Dec 1904
Address: Beaver