Death Certificate of Mrs. Bertha Welch

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

Certificate No 01062

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. Residence at time of death = Black Creek
20. Was deceased ever a U. S. solider or sailor? = (blank)
21. Name of physician, coroner or justice, = J. J. Laird
22. Residenc 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 = (blank)