VITAL - Death: Carl Peter Hansen; Umbria, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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note: transcribed from deteriorating original document
State Board of Health File No.: 423
Stamped File No.: 040112

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

Full Name of Deceased: Carl Peter Hansen
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: 
Date of Birth: 
Age: abt 45y
Single, Married, Widowed or Divorced: 
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: Mrs. N. F. McIntosh, Ogden
Place of Burial: Evanston, Wyoming
Date of Burial: 
Undertaker & Address: A. F. Richey, Ogden

Date of Death: 11 Aug 1904
Attended Date: 
Time of Death: 3 pm
Chief Cause of Death: railroad accident
Where contracted: 
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: Abraham Zundel, coroner
Date of Signature: 11 Aug 1904
Address: Brigham City