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State of Utah—Death Certificate 1. Place of Death 2. Full Name: John Stephen Edwards Personal and Statistical Particulars 3. Sex: Male 4. Color or Race: White 5. Single, Married, Widowed, or Divorced: Married 6. Date of Birth: Jan. 1st, 1851 8. Occupation of Deceased 9. Birthplace: Salt Lake, Utah 10. Name of Father: John Edwards 14. Informant: Ettie Pratt Edwards 15. Filed: Jan. 20, 1922 Medical Certificate of Death 16. Date of Death: Jan. 17, 1922 17. I Hereby Certify, That I attended deceased from Nov. 14, 1921, to Nov. 15, 1921, that I last saw him alive on Nov. 14, 1921, and that death occurred, on the date stated above, at 1 a.m. The cause of death was as follows: Chr. Myocarditis Contributory: not known 18. Did an operation precede death? No. Signed: A.A. Anderson, M.D. 19. Place of Burial, Cremation or Removal: City Cem. 20. Undertaker: Carl Eddington |
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