DEATH CERTIFICATE: Mark Fotheringham; Beaver co., Utah

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State Board of Health File No.: 10
Stamped File No.: 0400008

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: Mark Fotheringham
Former or Usual Residence: Beaver
Sex: Male
Color: White
Date of Birth: 
Age: 7y
Single, Married, Widowed, Divorced: Single
Birthplace: 
Name of Father, Birthplace: A. L. Fotheringham
Maiden Name of Mother, Birthplace: Matilda

Occupation: 
Informant: A. L. Fotheringham
Address: Beaver

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

Medical Certificate of Death
Date of Death: 13 Mar 1904
Time: 
Chief cause: pneumonia
Where contracted: 
Duration: 
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: Ward Christian, M.D.
Date: 
Address: 

Transcribed from Deteriorating Original Document