VITAL - Death: Fern Petersen; Bear River City, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 70
Stamped File No.: 

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

Full Name of Deceased: Fern Petersen
Former or Usual Residence: 
How long resident at place of death: 4m-4d
Length of residence in the city: 4m-4d
Length of residence in the state: 

Sex: F
Color: W
Date of Birth: 
Age: 4m-4d
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: Frede F. Petersen, Bear River City
Place of Burial: 
Date of Burial: 
Undertaker & Address: 

Date of Death: January 2, 1904
Attended Date: 
Time of Death: 
Chief Cause of Death: whooping cough
Where contracted: 
Duration: 
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: 
Date of Signature: 
Address: