William Bruce VIRT Death Certificate

INDIANA

STATE BOARD OF HEALTH

Certificate and Record of Death

Health Officer's Record Number: 9 [257 stamped in upper right corner]

County: Morgan

Township: Ray

Town or City: Paragon

Decedent's full Name: William Bruce Virt

Date of Death:

MONTH: 2

DAY: 21

YEAR: 1901

MEDICAL CERTIFICATE OF DEATH:

I hereby certify that I attended the deceased from Feb. 18 to Feb. 20, that I last saw him alive on Feb. 20, that he died on Feb. 20 about 7 o'clock P.M., and that to the best of my knowledge and belief the CAUSE OF DEATH was as hereunder written:

Disease causing death? Catarrhal Pneumonia

Duration: a week or more

Immediate cause of death? Convulsions

Duration: 24 hours

Contributory causes or complications, if any? Whooping Cough

Duration: [blank]

Post-mortem: [blank]

WITNESS my hand this 21 day of Feb. 1901 ["190" smudged by a drop of ink]

Signature of Physician, Coroner or Health Officer: U. H. Farr, M.D.

Address: Paragon, Ind.

RECORD OF DEATH:

Age: [blank] years, 6 months, 20 days

Full Name of Deceased: William Bruce Virt

Sex: Male

Color: White

Residence: Paragon

Birthplace? Paragon

Place of Death? Paragon

Father's name in full? Harry Francis Virt

Father's Birthplace? Ind.

Mother's maiden name in full? Emma L. Whitesitt

Mother's Birthplace? Ind.

Date of Burial? Feb 21

Place of Burial? Fair View Cem

Signature of Undertaker: H. L. Begeman & Co.

Address of Undertaker: Paragon

Reported by: Emma Virt

Address: Paragon