Death Certificate of James Henry Douglas
May 29, 1943

(click to enlarge)

State of Utah
Certificate of Death

1. Place of Death
a. County: Weber
b. City or town: Ogden
c. Name of hospital or institution: Home, 2708 Harrison Blvd.
d. Length of stay: In this community: 75 years

2. Usual Residence of Deceased:
a. State: Utah
b. County: Weber
c. City or town: Ogden
d. Street No. 2708 Harrison Blvd.

3. a. Full Name: James Henry Douglas

4. Sex: M

5. Color or Race: W

6.a. Single, Widowed, Married or Divorced: W
6.b. Name of wife: Rintha Pratt

7. Birth date of deceased: Aug. 29, 1858

8. Age: 84 Years, 9 Months, 0 Days

9. Birthplace: Ogden, Utah

10. Usual occupation: furniture executive
11. Industry or business:

12. Father Name: Richard Douglas
13. Father Birthplace: England
14. Mother Maiden Name: Elizabeth Wadsworth
15. Birthplace: England

16. a. Informant’s own signature: M. P. Douglas
b. Address:

17. a. burial
b. Date thereof: 6/2/1943
c. Place: burial or cremation: Ogden City Cem.

18. a. Mortuary: Larkin and Sons
b. Signature of funeral director: Geo. F. Larkin
c. Address: 466-24th   d. License No. 29
e. Was body embalmed? Yes   f. Embalmer’s License No. 291

19. a. Date received: June 2, 1943

Medical Certification

20. Date of Death: May 29, 1943

21. I Hereby Certify, That I attended deceased from 9-24, 1941, to 5-29, 1943.  I last saw him alive on 5-29, 1943, death occurred on the date stated above, at 5:00 a.m.

Immediate cause of death: [See Image]

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

23. Signature:

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