Death Certificate of Alvin Augustus Beesley
Sept. 26, 1940

(click to enlarge)

State of Utah
Certificate of Death

1. Place of Death
a. County: Salt Lake
b. City: Salt Lake
c. Name of hospital: L.D.S. Hospital
d. Length of stay: In hospital: 4 days
In this community: 66 yrs.

2. Usual Residence of Deceased
a. State: Utah
b. County: Salt Lake
c. City: Salt Lake City
d. Street No. 533 11th Ave.

3a. Full Name: Alvin Augustus Beesley
3b. If veteran: No
3c. Social Security No. No

4. Sex: Male

5. Color or race: White

6a. Single, widowed, married or divorced: Married
6b. Name of wife: Ruby Pratt Beesley
6c. Age of wife if alive: 66

7. Birth date of deceased: April 26th, 1873

8. Age: 67 Years, 5 Months, 0 Days

9. Birthplace: Salt Lake City, Utah

10. Usual occupation: Retail Music Dealer
11. Industry of business: Music

12. Father Name: Ebenezer Beesley
13. Father Birthplace: Bicester, England
14. Mother Maiden Name: Unknown
15. Mother Birthplace: Unknown

16a. Informant’s own signature: J.P. Beesley
b. Address: 463 11th Ave.

17a. Burial
b. Date thereof: Sept, 29th, 1940
c. Place: burial: City Cemetery

18a. Mortuary: The White chapel Inc.
b. Signature of funeral director
c. Address: Salt Lake City    d. License No. 107
e. Was body embalmed? Yes    f. Embalmer’s License No. 130

19a. Date received: Sept. 28, 1940

Medical Certification

20. Date of Death: Sept. 26th, 1940

21. I Hereby Certify, That I attended deceased from Sept. 6, 1940 to Sept. 26, 1940; I last saw him alive on Sept. 26, 1940, death occurred on the date stated above, at 4:40 p.m.

Immediate cause of death:

Coronary Occlusion
Duration: 3 weeks

Other conditions: Acute Diabetes  [See Image]

22. If death was due to external causes, fill in the following:

23. Signature: D.E. Smith
9-28-1940  Address: 312 M.G. Bldg.

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