Death Certificate of Samuel Heber Kimball
Apr. 18, 1943

death certificate of samuel heber kimball
(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: General Hospital
d. Length of stay: In hospital: 2 days
In this community: 16 years

2. Usual Residence of Deceased
a. State: Utah
b. County: Salt Lake
c. City: Salt Lake
d. Street No. 233 North Vine Street

3. a. Full Name: Samuel Heber Kimball

4. Sex: Male

5. Color or Race: White

6. a. Single, widowed, married or divorced: Married
6. b. Name of wife: Rosebelle Thomas Kimball
6. c. Age of wife if alive: 72 years

7. Birth date of deceased: Dec. 9th, 1851

8. Age: 91 Years, 4 Months, 9 Days

9. Birthplace: Salt Lake City, Utah

10. Usual occupation: Farmer
11. Industry or business: for self

12. Father Name: Heber C. Kimball
13. Father Birthplace: England
14. Mother Maiden Name: Anna Skeen
15. Birthplace: England

16. a. Informant’s own signature: S. Heber Kimball
b. Address: 608 So. 5th East

17. a. Removal
b. Date thereof: 4/20/1943
c. Place: burial or cremation: Vernal, Utah

18. a. Mortuary: Lindquist-Fernelius
b. Signature of funeral director: Jos. P. Fernelius
c. Address: 2128 So. State   d. License No. 52
e. Was body embalmed? Yes   f. Embalmer’s License No. 182

19. a. Date received: Apr. 20, 1943

Medical Certification

20. Date of Death: April 18th, 1943

21. I Hereby Certify, That I attended deceased from April 16, 1943 to April 18, 1943; I last saw him alive on April 18, 1943; death occurred on the date stated above, at 7:45 a.m.

Immediate cause of death: Cardio-vascular renal disease with terminal uremia
Duration: 30 yrs, 4 days

Due to: Age

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

23. Signature: Geo. N. Curtis. Co. Phys.
April 20, 1943  Address: 2033 So. State

Return to histories of Samuel Heber Kimball