MISSOURI DEATH CERTIFICATE
Place of death
County: Cass
Township or village: Strasburg
City: nothing listed
Registration district number: 139
Primary registration district number: 4093
File number: 38872
Registered number: 19
Full name: Died Un-named
Sex: male
Color or race: white
Single, married, widowed or divorced (write word): single
Date of birth: February 29, 1836
Age: nothing listed
Occupation of deceased
trade profession or particular kind of work: at home
general nature of industry, business or establishment in which employed (or employer): nothing listed
Birthplace: Strasburg, Missouri
Name of father: Taylor B. Carpenter
Birthplace of father: Owingsville, Kentucky
Maiden name of mother: Helen L. Hartleder
Birthplace of mother: Gray Summit, Missouri
Informant: Taylor Carpenter address: Peculiar, Missouri
Date filed: December 5, 1913 Registrar: W. Beckman
Date of death: December 4, 1913
I hereby certify, that I attended the deceased from December 4, 1913 to December 4, 1913, that I last saw him alive on December 4, 1913, and that death occurred, on the date stated above at 9:00 AM
The cause of death was as follows: premature birth
Contributory causes: nothing listed
Place of burial, cremation or removal: Strasburg Cemetery date:August 13, 1919
20. Undertaker: Parker & Hon Pleasant Hill, Missouri
