VITAL - Death: Cirus Alvord Campbell; Rosette, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 35
Stamped File No.: 0400119

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

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

Sex: male
Color: white
Date of Birth: 15 Oct 1903
Age: 10m26d
Single, Married, Widowed or Divorced: single
Name of Spouse: 
Birthplace: Rosette
Name & Birthplace of Father: Jonathan Campbell, North Ogden
Maiden Name & Birthplace of Mother: Sarah J. Raleigh, Salt Lake City
Occupation: 
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: Jonathan Campbell, Rosette
Place of Burial: Park Valley
Date of Burial: 12 Sep 1904
Undertaker & Address: sexton E. W. Carter, Park Valley

Date of Death: 10 Sep 1904
Attended Date: 
Time of Death: 9 pm
Chief Cause of Death: cholera infantum
Where contracted: Rosette
Duration: 2 days
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: Jonathan Campbell, Sarah J. Campbell, parents
Date of Signature: 11 Sep 1904
Address: Rosette