Alice Jerome Pratt
Dec. 14, 1923

death certificate of alice jerome pratt
(click to enlarge)

State of Utah—Death Certificate

1. Place of Death
County: Salt Lake
City: Salt Lake
No. 479 South 6th East

2. Full Name: Alice Jerome Pratt
a. Residence. No. 479 So. 6th East.
Length of residence in city where death occurred: 6 yrs.

Personal and Statistical Information

3. Sex: Female

4. Color or Race: White

5. Single, Married, Widowed or Divorced: Widow
5a.Wife of Nephi Pratt

6. Date of Birth: Dec. 14, 1852

7. Age: 71 yrs

8. Occupation of Deceased
a. Merchant
b. Retail Grocery Store

9. Birthplace: Texas

10. Name of Father: John Alexander Ray

11. Birthplace of Father: Va.

12. Maiden Name of Mother: Mary Young

13. Birthplace of Mother: Texas

14. Informant: Dr. A.N. Hanson
Address: 1385 Hale Ave.

15. Filed: Dec. 16, 1923

Medical Certificate of Death

16. Date of Death: Dec. 14, 1923

17. I Hereby Certify, That I attended deceased from Oct. 11, 1912, to Dec. 14, 1923, that I last saw her alive on Dec. 13, 1923 and that death occurred, on the date stated above, at 12 p.m., noon.

The cause of death was as follows: Chronic Myocarditis
Duration: 5 yrs

Contributory: Diabetes Mellitus
Duration: 14 yrs

18. Did an operation precede death?  No.
Was there an autopsy? No.
What test confirmed diagnosis? Laboratory.

Signed: Dr. Hanson, M.D.

19. Place of Burial, Cremation, or Removal: City Cemetery
Date of Burial: Dec. 16, 1923

20. Undertaker: Qualtrough-Allcott Co.
Address: City

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