VITAL - Death: John William Simpson; Grouse Creek, Box Elder co., Utah

Transcribed & submitted by W. D. Samuelsen
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State Board of Health File No.: 3
Stamped File No.: 0400090

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

Full Name of Deceased: John William Simpson
Former or Usual Residence: Grouse Creek
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: 14 Mar 1880
Age: 23y6m16d
Single, Married, Widowed or Divorced: married 
Name of Spouse: 
Birthplace: Grouse Creek
Name & Birthplace of Father: Jas R. Simpson, England
Maiden Name & Birthplace of Mother: Ellen Shaw, England
Occupation: farmer
Type of occupation: 
Date last worked: 
Total time (years) in this occupation: 
Informant & Address: Geo. A. Blanthorn, Grouse Creek
Place of Burial: Grouse Creek
Date of Burial: 17 Mar 1904
Undertaker & Address: 

Date of Death: 14 Mar 1904
Attended Date: 
Time of Death: 11 pm
Chief Cause of Death: fall from horse
Where contracted: Grouse Creek
Duration: 8 hours
Contributory if any: 
Where Contracted: 
Duration: 
Autopsy: 
Signed: 
Date of Signature: 
Address: