DEATH CERTIFICATE: John Arthur Lewis; Beaver co., Utah

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State Board of Health File No.: 24
Stamped File No.: 0400025

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: John Arthur Lewis
Former or Usual Residence: Frisco, 22 years
Sex: male
Color: white
Date of Birth: 5 Nov 1830
Age: 43y 9m 1d
Single, Married, Widowed, Divorced: widower
Birthplace: Wales
Name of Father, Birthplace: John Arthur Lewis, Wales
Maiden Name of Mother, Birthplace: unknown, Wales

Occupation: teamster
Informant: Mrs. John E. Jones
Address: Frisco

Place of Burial: Frisco
Date of Burial: 7 Aug 1904
Undertaker: 
Address: 

Medical Certificate of Death
Date of Death: 6 Aug 1904
Time: 5:30 pm
Chief cause: fracture 2nd cervical vertebra
Where contracted: Frisco
Duration: 
Contributory if any: thrown out of a cart by accident
Where contracted: 
Duration: 
Signed Doctor: F. H. Lay, M.D.
Date: 6 Aug 1904
Address: Frisco