VITAL - Death: Melvian Barlow; Grouse Creek, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 69
Stamped File No.: 0400105

Place of Death: 
Precinct of: 
City, Town or Village: Grouse Creek
Street and No.: 

Full Name of Deceased: Melvian Barlow
Former or Usual Residence: 
How long resident at place of death: 
Length of residence in the city: 
Length of residence in the state: 

Sex: female
Color: white
Date of Birth: 28 Jun 1904
Age: 1 day
Single, Married, Widowed or Divorced: 
Name of Spouse: 
Birthplace: Grouse Creek
Name & Birthplace of Father: Jessie Barlow, Grouse Creek
Maiden Name & Birthplace of Mother: Anie Paskett, Grouse Creek
Occupation: 
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: G. A. Blanthorn, Grouse Creek
Place of Burial: 
Date of Burial: 
Undertaker & Address: 

Date of Death: 28 Jun 1904
Attended Date: 
Time of Death: 7 pm
Chief Cause of Death: premature birth	
Where contracted: 
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: 
Date of Signature: 
Address: