Elizabeth McDANIEL (Bastin) Death Certificate
Indiana State Board of Health
Certificate of Death
Place of Death:
County of Morgan
Township of [blank]
Village of [blank]
or
City of Martinsville (No. [blank], [blank] St.; [blank] Ward]
Registered No. 72
FULL NAME Elizabeth Bastin
PERSONAL AND STATISTICAL PARTICULARS
SEX: Female
COLOR: White
DATE OF BIRTH: Nov. 6, 1835
AGE: 75 years, 11 months, 29 days
SINGLE...: Widow
NAME OF HUSBAND: Henry A. Bastin
BIRTHPLACE OF DECEASED: Indiana
NAME OF FATHER: James McDaniel
BIRTHPLACE OF FATHER: North Carolina
MAIDEN NAME OF MOTHER: Matilda Lewis
BIRTHPLACE OF MOTHER: North Carolina
OCCUPATION OF DECEASED: Housekeeper
The above stated personal particulars are true to the best of my knowledge and belief:
(Informant) H. M. Bastin
(Address) R. R. No. 8, Martinsville
Burial Permit Issued by: F. R. Maxwell
MEDICAL CERTIFICATE OF DEATH:
DATE OF DEATH: Nov. 4, 1911
I HEREBY CERTIFY, That I attended deceased from Nov 3, 1911 to Nov 4 1911 that I last saw her alive on Nov 3, 1911 and that death occurred, on the date stated above, at 3 P.M. The CAUSE OF DEATH was as follows:
Influenza
[blank] (Duration) [blank] (Days)
Contributory [blank]
[blank] (Duration) [blank] (Days)
(Signed) A. A. Sweet, M.D.
Nov 4, 1911 (Address) Martinsville, Ind
PLACE OF BURIAL OR REMOVAL: Ellettsville
DATE OF BURIAL: Nov. 6, 1911
UNDERTAKER: Wilhite & Sons
NO. OF LICENSE: 845
ADDRESS: Martinsville
WAS THE BODY EMBALMED? Yes
Transcription by John C. Hepner, 1998