Death Certificate of John Avis
(C. Avis Catalog entry #972)
INDIANA STATE BOARD OF HEALTH
CERTIFICATE OF DEATH
Perry County
Town or city: Derby
Decedent: John Avis
Date of Death: December 10 1899
MEDICAL CERTIFICATE OF DEATH
I hereby certify that I attended the deceased from Dec 8 to Dec 10, that I last saw him alive at Dec 10, that he died on Dec 10 ___ pm and that to the best of my knowledge that the cause of death was as hereunder written:
[?] causing death?: Hernia right side - duration 2 days
Immediate cause of death? Hernia right side - duration 2 days
Contributory causes or complication if any? Strangulated - duration 2 days
Post mortem -- No
Witness my hand this 20 day of April 1901
Signature J. B. Bennett
Address, Derby, Ind
RECORD OF DEATH
Age: 63 years 11 months 8 days, Sex: Male, Color: White
Full name of deceased: John Avis
Residence: Derby, Indiana
Occupation: None
Birthplace: Perry County, Ind
Place of death: Derby, Ind
Father's full name: James Avis
Father's birthplace: Md.
Mother's maiden name in full: Sarah Miller
Mother's birthplace: Perry Co., Ind.
Date of burial: December 11 - 1899
Place of burial: Derby, Ind
Signature of undertaker: J. W. Davis
Recorded by: J. B. Bennett Address: Derby, Ind
Address of undertaker: Derby, Ind