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

Transcribed & submitted by W. D. Samuelsen
***********************************************************************
Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
http://www.usgwarchives.net/ut/utfiles.htm
http://files.usgwarchives.net/ut/boxelder/vitals/deaths/1904/unknown.txt
***********************************************************************
State Board of Health File No.: 
Stamped File No.: 

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

Full Name of Deceased: unknown
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: charred
Date of Birth: 
Age: 
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: A. F. Richey, Ogden, Utah
Place of Burial: City Cemetery, Ogden
Date of Burial: 27 Feb 1904
Undertaker & Address: A. F. Richey, Ogden, Utah

Date of Death: 19 Feb 1904
Attended Date: 
Time of Death: 2:10 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: