Death Certificate of Lizzie Mailahn

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

Certificate No 120 (01860)

#	Question	Answer
1

1. Full name of deceased = Lizzie Mailahn
2. Maiden name (if wife or widow), = (blank)
3. Color and sex, = White . Female
4. Race, = Caucasian
5. Occupation of deceased = Housework
6. Age (years, months and days), = 14 years, 9 mos, 18 dys
7. Name of father, = Louis Mailahn
8. Birthplace of father = Germany
9. Name of mother, = Augusta Mailahn
10. Birthplace of mother = Germany
11. Birthplace of deceased = Town of Ellington
12. Date of birth of deceased = May 19, 1892
13. Condition (single, married, widowed, or divorced, = Single
14. Name of wife or husband of deceased = (blank)
15. Date of death, = March 7th 1907
16. Cause of Death {Primary, Secondary} = Phthisis Heart Failure
17. Duration of disease = Several months
18. Place of death = at home
19. Residence at time of death = Town Ellington
20. Was deceased ever a U. S. solider or sailor? = (blank)
21. Name of physician, coroner or justice, = E. N. Sartell M.D.
22. Residenc of such person = Black Creek, Wis.
23. Name of undertaker or other person conducting burial = Rev. R. Hinnenthal
24. No. and date of burial permit = 20 - March 9th 1907
25. Place of burial = Town Cemetery Black Creek
26. Date of certificate = March 8th 1907
27. Date of registration = Apr 26 1907
28. Other important facts not related = (blank)