VITAL - Death certificate: Thomas Frederik Samuelsen; Salt Lake co., Utah

submitted by W. David Samuelsen (dsam at sampubco dot com)
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Certificate of Death
State File No.: 417
Registrar's No: 542
1. Place of Death
a. County: Salt Lake
b. City or Town: Salt Lake
c. Length of Stay: 
d. Full Name of Hospital or Institution: Salt Lake General Hospital
2. Usual Residence
length of residence: 42 years
a. State: Utah
b. County: Salt Lake
c. City or Town: Salt Lake
d. Street Address: 135 « E 4th South
3. Name of Deceased: Thomas Frederick Samuelsen
4. Date of Death (spell out full month) : Feb. 22, 1937
5. Sex: M
6. Color or Race: white
7. Married, Never Married, Widowed, Divorced: married
8. Date of Birth (spell out full month) : February 9, 1875
9. Age: 62 years 13 days
10a. Usual Occupation: laborer
10b. Kind of Business or Industry: day
11. Birthplace: Copenahgen, Denmark
12. Citizen of What Country?: 
12b. How long in US if of foreign birth: 53 years
13. Father's Name, place of birth: Christen Samuelsen, Denmark
14. Mother's Maiden Name, place of birth: Lence, Topholt, Denmark
14b. Husband's or Wife's Name: Sarah M. Reeves
15. Was Deceased in US. Armed Forces?: 
16. Social Security No.: 
17. Informant and Address: Charles F. Samuelsen, Twin Falls, Idaho
18. Cause of Death: 
I. Disease of Condition: carcinoma of right lung
Interval between onset and death: unknown
II. Antecedent causes: 
Interval between onset and death: 
19a. Date of Operation: 
19. Major findings of Operation: 
20. Autopsy?: no
21a. Accident, Suicide or Homicide: 
21b. Place of Injury: 
21c. City: 
21d. Time of Injury: 
21e. Injury Occured: 
21f. How did Injury Occur?: 
22. Certify Dates & Time: Feb. 11, 1937 to Feb. 22, 1937, 10:55 pm
23a. Signature: Stewart A. Wright, Res. M.D.
23b. Address: Salt Lake Gen. Hospital
23c. Date Signed: Feb. 23, 1937
24a. Burial, Cremation, Removal: Burial
24b. Date: Feb 26, 1937
24c. Name of Cemetery or Crematory: City
24d. Location: Salt Lake City
Date Rec'd by Local Reg.: Febr., 25, 1937
Registrar's Signature: T. J. Howell, M.D.
25. Funeral Director's Signature & Address: Neil O'Donnell, Salt Lake City

Comments: (Use for listing of correct information by submitter)
Thomas born in Skaerum, Denmark, not Copenhagen
Thomas' mother was Nicoline Kristine Jensen Samuelsen
Came to USA in 1884 with his mother.