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by: Nancy at DNBurton@afo.net State of Illinois Certificate of Stillbirth County Clerk's Record Registered No. 4 Registration Dist. No. 411, Primary Dist. No. 3288 Place of Stillbirth: County of Jefferson, Mt. Vernon City, 714 Perkins St. Name of Child: Infant of Lon Grigsby Sex of Child: Male Legitimate?: Yes Date of Stillbirth: April 11, 1933 FATHER: Full Name: Lon Grigsby Residence: Sullivan, Illinois Color: White Age at Last Birthday: 65 Birthplace: Unknown Occupation: Truckfarmer MOTHER: Full Maiden Name: Hazel McNew Residence: Mt. Vernon, Illinois Color: White Age at Last Birthday: 30 *Birthplace: East St. Louis, MO Occupation: Housekeeper Number of Children of This Mother born alive and now living: 1, born alive but now dead: 0, stillborn: 1 Informant: Hazel Grigsby, Mt. Vernon, Illinois CERTIFICATE OF ATTENDING PHYSICIAN OR MIDWIFE: "I hereby certify that I attended the birth of this child, which was BORN DEAD April 11, 1933, ___(left blank)m. Period of uterogestation _(left blank)_. Cause of Stillbirth: Unknown. Signature of attendant: J E Dixon, Address: Mt. Vernon, Telephone: 606" CERTIFICATE OF UNDERTAKER Place of Burial Cremation or Removal: County Farm Date: April 12, 1933 Undertaker: W. B. Myers, Myers Funeral Service Address of Undertaker: Mt. Vernon, Ill Date filed: 4, 13, 1933 Registrar: W. F. Carroll, Mt. Vernon, Ill * Birthplace of mother is incorrect. Her birth and death certificates both state place of birth was Jefferson County, Illinois. |
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