| Source Number |
Repository |
Call Number |
|
|
Original Document |
N/A |
| Indexed |
Condition |
Time Period |
| N/A |
Excellent |
1909 |
| Research Date |
Description of Source |
| N/A |
State of Wisconsin Department of Health- Bureau of Vital Statstics Copy of Death Record
(Thomas P. DERRICKSON) |
| Search Subject |
The certificate reads:
Place of Death
Count of Richland
Township of Hiteca(?)
Page No. 42 (to be filed with the register of deeds)
11 January 1910
(If an infant not named give family name) Full Name: Thomas P. Derrickson
Personal and Statistical Particulars:
Sex: Male
Color: White
Date of Birth: 15 October 1820
Age: 90 years, 1 month, 24 days
Widowed
Birthplace: America, U.S.
Unable to find any dates of parents
Occupation: Farmer
Medical Certificate of Death
Date of Death: 9 December 1909
I hereby certify that I attended deceased from 11 Nov 1909 to 9 Dec 1909 that I last saw
h(im,er) alive on ? and that death occured on the date stated above at ?. The cause of death
was as follows:
Senile Debility
Several years (duration)
P.G. Laschi M.D.
Hiteca(?) Wisconsin
The above stated personal particulars are true to the best of my knowledge and belief
J. Hamilton
from Bliss(?)
Filed: 7 January 1910 Burt Parfrey (Local Register)
Place of Burial or Removal: Derrickson Reservation
Undertaker: Paris
Address: Richland Center
State of Wisonsin
County of Richland
I, Kay Peterson, Deputy Register of Deeds in and for said County do hereby certify that
the adjacent photograph is a true and correct copy of the transcript on file in this office.
In testimony whereof, I have hereunto set my hand and affixed by offical seal the 22nd day
of October A.D., 1999.
(signed) Kay Peterson, Deputy (Deputy Register of Deeds, Richland County, WI).
This record has a raised seal. It is illegal to copy it.
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