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1. place of death: Fredonia, Coconino
length of stay in hosp or institution: none
length of residence in town where death occured:
how long in state where death occured: 49 years 10 months
3. sex: male
4. color: white
5. widowed
5a: husband or wife: Francis T Theobald
6. date of birth: Feb 12 1879
7. age: 83 months:9 years 10 days: 7
8. trade: farmer
11. time spent occupation:
12. birth place: Salt Lake City, Salt Lake County, Utah
13. name father: Orson Pratt
14. father birthplace: NH, Hartford
15. mother maiden name: Adelia Ann Bishop
16. mother birthplace: Salt Lake City, Utah
17. informant: WW Seegmiller Salt Lake City
18. funeral director: Warren C. Judd Fredonia Arizona
21. date of death: 10-7-35 at 2 AM
22. I heareby certify that attendded the deceased from9-23-1935 to 10-7-35. I lost saw him alive on 10-51935Cause of death--senile debility with myocardialdegenerative. Clinical, no autopsy
Norris, MD--Kanab Utah |
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