VITALS - Death Certificate of:  Donald Holbrook; Fillmore, Millard co., Utah

Transcribed by Stephen D. Robison (kinseeker @ hotmail.com)
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FHL Film # 2230661, State of Utah, Death Certificates, Millard County:
Certificate Number: 0400643
Death place: Fillmore
Name: Donald Holbrook
Usual residence: Fillmore
How long resident: All his life

PERSONAL AND STATISTICAL PARTICULARS
Sex: Male
Color: white
Birth date: Nov 17 1904
Age: 0 y 0 m 5 d
Marital status: --
Birth place: Fillmore Utah
Father: Grantly Holbrook
Father's birth place: Fillmore
Mother: Jessie Mitchell
Mother's birth place: Fillmore
Occupation: --
Informant: Heber J Mitchell Jr.
Informant's address: Fillmore, Utah
Burial place: Fillmore
Burial date: Nov 22 1904
Undertaker: Joseph Seguine
Undertaker's address: Fillmore, Utah
Filed:
Registrar:

MEDICAL CERTIFICATE OF DEATH
Death date: Nov 21 1904
Cause: Premature Birth
Where contracted: --
Duration: --
Contributory: --
Where contracted: --
Duration: --
Doctor: J. C. Robison
Dated: Nov 22 1904

Permission is hereby granted to bury/ship the body of the person above described
Health Officer: J. C. Robison M.D.
Address: Fillmore
Date: Nov 22 1904