Death Certificate of William Lyman Shiverick
Sept. 3, 1948

(click to enlarge)

State of Utah
Certificate of Death

1. Place of Death
a. County: Salt Lake
b. City: Salt Lake City
c. Name of hospital or institution: 257 10th Avenue
d. Length of stay: In this community: 40 years

2. Usual Residence of Deceased:
a. State: Utah
b. County: Salt Lake
c. City: Salt Lake City
d. Street No. 257 10th Avenue
e. In this community: 40 years

3. a. Full Name: William Lyman Shiverick

4. Sex: Male

5. Color or race: White

6. a. Single, widowed, married or divorced: Married
6. b. Name of husband or wife: Neva Pratt
6. c. Age of wife if alive: 74 yrs.

7. Birth date of deceased: Jan. 23, 1855

8. Age: 93 Years, 7 Months, 10 Days
9. Birthplace: Middleboro, Massachusetts
10. Usual occupation: Merchant—Shoe Store Mgr.
11. Industry or business: retired
12. Father Name: William Shiverick
13. Father Birthplace: Massachusetts
14. Mother Maiden Name: Betsy Nye
15. Mother Birthplace: Massachusetts
16. a. Informant’s own signature: Mrs. Fredrick B. Cary
16. b. Address: Los Angeles, California

17. a. entombment
b. Date thereof: September 7, 1948
c. Place: burial or cremation: S.L. Memorial Mausoleum

18. a. Mortuary: Taylor Memorial Mortuary
b. Signature of funeral director: [See image]
c. Address: 125 N. Main   d. License No. 20
e. Was body embalmed? Yes   Embalmer’s License No. 259

19. a. Sept. 7, 1948

Medical Certification

20. Date of Death: September 3, 1948

21. I Hereby Certify, That I attended deceased from Jan. 1, 198, to Sept. 2, 1948; I last saw her alive on Sept. 2, 1948; death occurred on the date stated above, at 3:00 a.m.

Immediate cause of death: Inanition
Due to: Insideus to age 93

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

23. Signature: H. Anderson, M.D.
9/7/1948   Address: 401 --- Art Bldg.

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