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

Repository

Given names Surname Sosa Birth Place Death Age Place Last change
Joseph Bloemer
May 10, 1834
186 Germany
8 February 8, 1912
108 77 Effingham, IL, US
Sunday, November 30, 2014 5:44 AM
Given names Surname Age Given names Surname Age Marriage Place Last change
Media objects
Media Title Individuals Families Sources Last change
Sources
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