DEATH CERTIFICATE: James Edwin Thompson; Beaver co., Utah

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State Board of Health File No.: 35
Stamped File No.: 0400037

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: James Edwin Thompson
Former or Usual Residence: Beaver
Sex: male
Color: white
Date of Birth: 7 Sep 1869
Age: 35y 1m 13d
Single, Married, Widowed, Divorced: married
Birthplace: Beaver
Name of Father, Birthplace: James Thompson, England
Maiden Name of Mother, Birthplace: Rebecca Gale, Australia

Occupation: laborer
Informant: Willard Thompson
Address: Beaver

Place of Burial: Beaver
Date of Burial: 19 Oct 1904
Undertaker: Joseph Ash
Address: Beaver

Medical Certificate of Death
Date of Death: 17 Oct 1904
Time: 1 am
Chief cause: inflamation of brain (or arasimitis)
Where contracted: Beaver
Duration: 25 days
Contributory if any: 
Where contracted: 
Duration: 
Signed Doctor: Jno. Ward Christian, M.D.
Date: 19 Oct 1904
Address: Beaver