Surber, Sallie
| Date
of Report (Month/Day/Year) |
1. Name 2. Sex and Color |
1.
Age (Year/Month/Day) 2. Occupation |
| Mar.11,1884 | 1. Sallie A Surben | 1. 56 yrs |
| 2.
Sex - Female Color - White |
2. | |
| Date of Death (Month/Day/Year AM or PM) |
Single, Married, Widower or Widow |
1.
Nationality 2. Where Born |
| Jan.30, 1884 AM | Widow | 1. American |
| 2. Monroe Co.MO. | ||
| How long Resident in the state. | 1.
Place of Death 2. Cause of Death |
1.
Complication 2. Duration of Complication 3. Duration of Disease |
| 53 | 1. Audrain Co.MO. | 1. Lungs were not sound. |
| 2. Pneumonia | 2. | |
| 3. 6 days | ||
| 1.
Place of Burial 2. Date of Burial |
1.
Name of Undertaker 2. Place of Business |
Name
and Residence of Physician Returning Certificate |
| 1. Lockridge Graveyard | 1. J M Menefee | T P Rothwell MD, Mexico,MO. |
| 2. Jan.31,1884 | 2. Mexico,MO. | |