Death Certificate of Mrs. Bertha Welch

From Death Records of Outagamie County, Wisconsin - Vol 3 (Pre Oct 1907)

Certificate No 01062

#	Question	Answer
1	Full name of deceased	Mrs. Bertha Welch
2	Maiden name (if wife or widow)	Bertha Mailahn
3	Color and sex	White Female
4	Race	Caucasian
5	Occupation of deceased	Housework
6	Age (years, months and days)	25 years, 4 mo, 1 day
7	Name of father	Louis Mailahn
8	Birthplace of father	Germany
9	Name of mother	Gusta Mailayn
10	Birthplace of mother	Wisconsin
11	Birthplace of deceased	Black Creek
12	Date of birth of deceased	July 20 1880
13	Condition (single, married, widowed, or divorced)	Married
14	Name of wife or husband of deceased	Jessie Welch
15	Date of death	Nov 21 1905
16	Cause of Death {Primary, Secondary}	Tubercular abcess - Tuberculosis of lungs
17	Duration of disease	about 2 months
18	Place of death	Black Creek
19	Resident at time of death	Black Creek
20	Was deceased ever a U.S. soldier or sailor?
21	Name of physician, coroner or justice	J. J. Laird
22	Residence of such person	Black Creek
23	Name of undertaker or other person conducting burial	Gus Strassburger
24	No. and date of burial permit	6 - Nov 21 1905
25	Place of burial	Black Creek Cemetery
26	Date of certificate	Nov 21 1905
27	Date of registration	Nov 24 1905
28	Other important facts not related