Sarah Marilda WAIT (Spoor) Death Certificate

INDIANA

STATE BOARD OF HEALTH

Certificate and Record of Death

County: Stark

Township: California

Town or City: [blank]

Health Officer's Record Number: [blank] [stamped number]:128

Decedent's full Name: Sarah M. Spoor

Date of Death: April 24, 1901

MEDICAL CERTIFICATE OF DEATH

I hereby certify that I attended the deceased from Apr 19/01 to Apr 24/01, that I last saw her alive on April 23/01, that She died on Apr 24/01 about 11 o'clock A.M., and that to the best of my knowledge and belief the CAUSE OF DEATH was as hereunder written:

Disease causing death? Pneumonia

Duration: Apr 19 to 24/01

Immediate cause of death? Embolism

Duration: from 10 to 24 hours

Contributory causes or complications, if any? [blank]

Duration: [blank]

Post-mortem: [blank]

WITNESS my hand this 24th day of April, 1901.

Signature of Physician, Coroner . . .: M. C. Boner, M.D.

Address: Knox, Stark Co Ind.

RECORD OF DEATH

Age: Eighty years

Full Name of Deceased: Sarah Marilda Spoor

Sex: female

Color: White

Residence: Toto, California Township Starke Co. Ind

Single, Married [struck through], Widow

Occupation? Farmer

Birthplace? Ohio

Place of Death? Knox Ind

Father's name in full? Cyrus Wait

Father's Birthplace? Vermont

Mother's maiden name in full? Laura Withe

Mother's Birthplace? New York State

Date of Burial? April 27th 1901

Place of Burial? Round Lake Ind

Signature of Undertaker: J. C. Jones

Address of Undertaker: Knox Ind

Reported by: Dr. M. C. Bonner

Address: Knox Ind