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Missouri State BOARD OF HEALTH
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
MRS. AMANDA A. SHIRK [Amanda Alice Shirk]
.1. PLACE OF DEATH:
. . . COUNTY: Jasper
. . . CITY: Webb City [Missouri]
. . . REGISTRATION DISTRICT NO. 417
. . . FILE NO. 23654
. . . REGISTERED NO. 135
2. FULL NAME: Mrs. Amanda A. Shirk
. . . RESIDENCE: 12 & Washington
. . . LENGTH OF RESIDENCE IN CITY OR TOWN WHERE DEATH OCCURRED: 13 years
DATE OF DEATH: August 23, 1924
COUNTY: Jasper
CITY: Webb City [Missouri]
CERTIFICATE NUMBER: 23654
PERSONAL AND STATISTICAL PARTICULARS:
.3. SEX: Female
.4. COLOR OR RACE: White
.5. SINGLE, MARRIED, WIDOWED, DIVORCED: Widowed
.6. DATE OF BIRTH (Month, Day, Year): Dec. 5, 1858
.7. AGE (Years): ..... 73 ..... MONTHS: ..... 8 ..... DAYS: ..... 18
.8. OCCUPATION OF DECEASED: At Home
.9. BIRTHPLACE (City or Town): Akron ..... STATE OR COUNTRY: ..... Ohio
10. NAME OF FATHER: Peter Daniel
11. BIRTHPLACE OF FATHER: (State or Country): Maryland
12. MAIDEN NAME OF MOTHER: Lydia Eichenberger [or, Eickenberger?]
13. BIRTHPLACE OF MOTHER (State or Country): Penn.
14. INFORMANT: E.E. Stevens ..... (Address): Anderson, Mo.
15. FILED: Aug. 27, 1924 ..... R.M. [Stornes?] (Registar)
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH (Month, Day, Year): Aug. 23, 1924
17. I HEARBY CERTIFY, That I attended deceased from "Aug. 21, 1924" to Aug. 24, 1924" and that I last saw her alive on "Aug. 23, 1924," and that death occurred on the date stated above, at "10:00 P.M."
CAUSE OF DEATH: Cerebral Haemorrage [sic]; Apoplexy.
18. SIGNED: J.O.W. Barsau[?] ..... ADDRESS: Joplin, Missouri
19. PLACE OF BURIAL: Carterville Cem. DATE OF BURIAL: Aug. 26, 1924
20. UNDERTAKER: Webb City [ _?_ ] Co. ..... ADDRESS: Webb City.
.
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SOURCE:
The state archives now include actual scans of Missouri death certificates (1910-1957).
http://www.sos.mo.gov/archives/resources/deathcertificates
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