Benton Co., AR - Vitals - Caroline Rose

***********************************************
This file was contributed for use in the USGenWeb
Archives by: Sharon Hamilton <sharkay@cccexpress.com>

Copyright.  All rights reserved.
http://www.usgwarchives.net/copyright.htm
***********************************************
Arkansas State Board of Health
Bureau of Vital Statistics
Certificate of Death
1.  PLACE OF DEATH
County Benton
Registration District No. 29
File No. 49
Primary Registration District No. 3044
Inc. Town or City  Bentonville
[May 1928 is stamped diagonally across top.]
2.  FULL NAME   Caroline Rose
No residence listed.
PERSONAL AND STATISTICAL PARTICULARS
3.  Sex:  F
4.  Color or Race:   W
5.  Single, Married, Widowed, or Divorced:  widow
[No name for spouse listed.]
6.  Date of Birth:  Jany 1, 1854
7.  Age:  74 years, 2 months, 23 days
8.  Occupation of Deceased:  At Home
9.  Birthplace:  Carter Co., MO
10.  Name of Father:  Cop or Coss Davis
11.  Birthplace of Father:  DK
12.  Maiden Name of Mother:  Scaggs
13.  Birthplace of Mother:  DK
14.  Informant:  Whilty Kerr (first name looks like that but writing is 
poor)
                           Bentonville, Ark.
15.  Filed:  3/24, 1928    Whilty Rio Registrar (name hard to read)
MEDICAL CERTIFICATE OF DEATH
16.  Date of Death:  Mch 24, 1928
17.  I hereby certify, that I attended deceased from Mar. 20, 1928 to 
Mar 24, 1928 that I last saw h__ alive on ____ and that death occurred, 
on the date stated above, at 11:20 pm.  The Cause of Death was as follows:
Cronic Interstitial Brights Disease
129 Duration
18.  Signed:  P M Atkinson, M.D.
3/24/1928    Address:  Bentonville
19.  Place of Burial, Cremation, or Removal:  Bentonville, Ark
       Date of Burial:  3.26, 1928
20.  Undertaker:  K T Coll???  
       Address:  Bentonville