Death Certificate - Joseph Bloemer (1912)

Title
Death Certificate - Joseph Bloemer (1912)

Text
CERTIFICATE AND RECORD OF DEATH OF
1. Full Name: Joseph Bloemer
2. (a) Sex: Male (b) Color: White (c) Single Married Widowed Divorced: Married
3. (a) Birthplace: Germany (b) Date of Birth:
4. Age 78 Years - Month - Days __ Hours (If less than One Day old)
5. Died on the 8 Day of Feb 1912 at about 5 AM
6. Last Occupation: Farmer (Profession, Trade or Kind of Industry or Business)
7. { From Year __ To Year __
Previous Occupation (if any) __
From __ To __
8. Place of Death: Effingham (Township, Village or City) County of Effingham
** Second Column **
Registered No. __
Effingham County
9. How long in State: 40 Years
10. How long in U.S. if Foreign born __
11. { (a) Name of Father __
(b) Birthplace of Father __
12. { (a) Maiden Name of Mother __
(b) Birthplace of Mother __
The foregoing stated personal particulars are true to the best of my knowledge and belief
13. Informant __
Address __
** Only one column now **
14. Place of Burial St. anthonys cem

RepositoryIllinois Regoinal Archives Depository - Eastern Illinois University


 
Given names Surname GIVN SURN Sosa SOSA Birth SORT_BIRT Place NCHI Death SORT_DEAT Age AGE Place Last change CHAN SEX BIRT DEAT TREE
Joseph Bloemer
JosephAAAABloemerBloemerAAAAJoseph 0May 10, 18342391044183Germany88February 8, 191224194411057728397Effingham, IL, US  MYESYES