Death Certificate of Lizzie Mailahn

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

Certificate No 120 (01860)

#	Question	Answer
1	Full name of deceased	Miss Vina Mailahn
2	Maiden name (if wife or widow)
3	Color and sex	whtie - female
4	Race	Caucasian
5	Occupation of deceased	Housework
6	Age (years, months and days)	23 yrs, 0 mos, 20 Dys
7	Name of father	Louie Mailahn
8	Birthplace of father	Germany
9	Name of mother	Gusta Mailahn
10	Birthplace of mother	Dodge Co.
11	Birthplace of deceased	Black Creek
12	Date of birth of deceased	May 13 - 1884
13	Condition (single, married, widowed, or divorced)	single
14	Name of wife or husband of deceased
15	Date of death	June 14, 1907
16	Cause of death {Primary, Secondary	Tuberculosis of Lunge
17	Duration of disease	about one year
18	Place of death	Center
19	Resdience at time of death	Center
20	Was deceased ever a U. S. soldier or sailor?	No
21	Name of physician, coroner or justice.	J. J. Laird
22	Residence of such person	Black Creek, Wis.
23	Name of undertaker or other person conducting burial.	Strassburger
24	No. and date of burial permit	7 -
25	Place of burial	Black Creek Town Cem.
26	Date of certificate	June 14, 1907
27	Date of registration	Jul 2, 1907
28	Other important facts not related	~

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)