DEATH CERTIFICATE: Emma Willard Lay; Beaver co., Utah

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State Board of Health File No.: 916
Stamped File No.: 0400012

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

Full name of Deceased: Emma Willard Lay
Former or Usual Residence: Frisco
Sex: female
Color: white
Date of Birth: 2 Jun 1849
Age: 55y 2m 13d
Single, Married, Widowed, Divorced: married
Birthplace: New Jersey
Name of Father, Birthplace: Charles P. Broadwell, Shoeham Vermont
Maiden Name of Mother, Birthplace: Jennie Cuyler, New York

Occupation: 
Informant: F. H. Lay
Address: Frisco

Place of Burial: Mt. Olivet Cemetery, Salt Lake City
Date of Burial: 16 Aug 1904
Undertaker: O'Donnell & Co.
Address: Salt Lake City

Medical Certificate of Death
Date of Death: 15 Aug 1904
Time: 5 am
Chief cause: myclitis with paralysis
Where contracted: Frisco
Duration: 8 days
Contributory if any: neurasthenia
Where contracted: Denver, Colorado
Duration: 16 years
Signed Doctor: F. H. Lay, M.D.
Date: 15 Aug 1904
Address: Frisco