.
STATE:
Missouri
File Number:
15065
Registered #3910

CERTIFICATE OF DEATH

MISSOURI STATE BOARD OF HEALTH


Record transcribed from original recorded public records to avoid violation of direct reproduction/copyright laws.
This is not an official copy, but research of official documents are listed here for the purpose of family research.
This page will give the researcher a reference number and the location of where to find this official document.


Document obtained from Erlene Dudley
Transcribed by Kevin Everingham


DECEASED



DECEASED NAME:
Charles Everingham
SEX
M
DATE OF DEATH:
April 9, 1918
PLACE OF BIRTH:
Indiana
Place of Death:
St. Louis, MO
AGE
69
Date of Birth:
unknown 1849
OCCUPATION:
Night Watchman
City of DEATH:
Kansas City
County of DEATH:
--
STATUS:
Divorced
Time of DEATH:
8:30 P.M.
Color or Race:
White
ADDRESS:
1131 S. 12th St.
Registrar & Date of Registration:
M. Starkloff (Apr 13, 1918)
PARENTS

FATHER:
unknown
MOTHER:
unknown
Informant

Informant:
"coroner"
Address:
---
CAUSE



IMMEDIATE CAUSE:
Carbolic Acid Poisoning
INTERVAL:
-
CAUSE:
INTERVAL:
-
CONTRIBUTORY:
Suicide
PHYSICIAN:
R. Sitt M.D.
BURIAL

All Burial Information:
St. Mathews (4-13-1918)



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