DEATH CERTIFICATE: Ia Juana Lund Smith; Beaver co., Utah

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State Board of Health File No.: 18
Stamped File No.: 0400019

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: Ida Juana Lund Smith
Former or Usual Residence: Beaver City
Sex: female
Color: white
Date of Birth: 18 Jan 1866
Age: 38y 4m 20d
Single, Married, Widowed, Divorced: married
Birthplace: St. George, Washington co., Utah
Name of Father, Birthplace: Wilson, Lund, Morland England
Maiden Name of Mother, Birthplace: Ellen Nielson, Nestsirth, Denmark

Occupation: 
Informant: Seth N. Smith
Address: Beaver City

Place of Burial: Beaver City
Date of Burial: 9 Jun 1904
Undertaker: Jos. Ash
Address: Beaver

Medical Certificate of Death
Date of Death: 7 Jun 1904
Time: 3:20 pm
Chief cause: rheumatism of heart
Where contracted: Beaver
Duration: 3 days
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: I. E. Huffman, M.D.
Date: 8 Jun 1904
Address: Beaver