VITAL - Death: Owen Dermody; Jackson, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 151
Stamped File No.: 0400085

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

Full Name of Deceased: Owen Dermody
Former or Usual Residence: Hogup, Utah
How long resident at place of death: 
Length of residence in the city: 
Length of residence in the state: 

Sex: male
Color: dark
Date of Birth: 4 Sept 1868
Age: 35y5m15d
Single, Married, Widowed or Divorced: single
Name of Spouse: 
Birthplace: Beaver Dam, Wisconsin
Name & Birthplace of Father: blank
Maiden Name & Birthplace of Mother: blank
Occupation: 
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: D. L. Boyle, 2618 Lincoln
Place of Burial: Beaver Dam, Wisconsin
Date of Burial: unknown
Undertaker & Address: A. F. Richey

Date of Death: 19 Feb 1904
Attended Date: 
Time of Death: 3:30 pm
Chief Cause of Death: killed by explosion of dynamite
Where contracted: Jackson
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: G. W. Perkins, M.D.
Date of Signature: 22 Feb 1904
Address: Ogden