VITAL - Death: Louis Koutsumbas; Jackson, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 68
Stamped File No.: 0400065

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

Full Name of Deceased: Louis Koutsumbas
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: Greek
Date of Birth: 
Age: 26y
Single, Married, Widowed or Divorced: single
Name of Spouse: 
Birthplace: Greece
Name & Birthplace of Father: George Koutsumbas, Greece
Maiden Name & Birthplace of Mother: Marie Chauguris, Greece
Occupation: laborer
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: Bill Chauguris, Salt Lake City (cousin)
Place of Burial: M. V. Cemetery (Mountain View)
Date of Burial: 
Undertaker & Address: A. F. Richey, Ogden, Utah

Date of Death: 19 Feb 1904
Attended Date: 
Time of Death: 3:30 pm
Chief Cause of Death: R. R. Accident
Where contracted: 
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: Wm. Howley, coroner
Date of Signature: 
Address: