Death Certificate of Culbert King
Oct. 26, 1909

death certificate of culbert king
(click to enlarge)

State of Utah—Death Certificate

Place of Death
County of Garfield
Precinct of Coyote
City of Coyote

Full Name of Deceased: Culbert King
Former or Usual Residence: Fillmore
How long resident at place of death: 30 years

Personal and Statistical Particulars

Sex: Male

Color: White

Date of Birth: Jan. 31

Age: 73 years, 9 months, 26 days

Single, Married, Widowed, or Divorced: Widowed

Birthplace: Otisco Onondagna Co. N.Y.

Name of Father: Thomas R. King
Birthplace of Father: unknown
Maiden Name of Mother: Matildia Robinson
Birthplace of Mother: New York

Occupation: Farmer

Informant: Volney King
Address: Cowley Big Horn —–

Place of Burial: Coyote Garfield, Ut.
Date of Burial: Oct. 29, 1909

Undertaker: Geo. Black
Address: Coyote, Ut

Medical Certificate of Death

Date of Death: Oct. 26, 1909

I Hereby Certify, That I attended deceased from May 1909 to Oct. 26, 1909 that I last saw him alive on Oct. 26, 1909 and that death occurred, on the date stated above, at 11:30 a.m.

The cause of death was as follows:

Chief Cause: Dropsy
Where Contracted: unknown
Duration: 180 Days

Contributory: none

Signed: Minnie King Reg., M.D.
Date: Oct. 29, 1909  Address: Coyote

Filed: Nov. 4, 1909

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