VITAL - Death: Maggie Brain; Washakie, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 14
Stamped File No.: 0400055

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

Full Name of Deceased: Maggie Brain
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: Red
Date of Birth: 
Age: 45y
Single, Married, Widowed or Divorced: married
Name of Spouse: 
Birthplace: 
Name & Birthplace of Father: 
Maiden Name & Birthplace of Mother: 
Occupation: 
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: George M. Ward, Washakie
Place of Burial: Washakie
Date of Burial: Jan 25, 1904
Undertaker & Address: 

Date of Death: Jan 22, 1904
Attended Date: 
Time of Death: 
Chief Cause of Death: smallpox
Where contracted: Washakie
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: no physician
Date of Signature: 
Address: