Death Certificate of Anthony C. Ivins
Dec. 22, 1904
(click to enlarge)
State of Utah—Death Certificate
Place of Death
County of Salt Lake
City of Salt Lake City
Hospital: Holy Cross Hospital
Full Name of Deceased: Anthony C. Ivins
Former or Usual Residence: Salt Lake City
Personal and Statistical Particulars
Sex: Male
Color: White
Date of Birth: Don’t know
Age: 45 years
Single, Married, Widowed or Divorced: Widowed
Birthplace: Utah
Name of Father: Don’t know
Birthplace of Father: Don’t know
Maiden Name of Mother: Don’t know
Birthplace of Mother: Don’t know
Occupation: Typesetter
Informant: J.W. Hughes
Address: Salt Lake City, Utah
Place of Burial: City Cemetery
Date of Burial: Dec. 24, 1904
Undertaker: O’Donnell & Co.
Address: Salt Lake City, Utah
Filed: Dec. 29, 1904
Medical Certificate of Death
Date of Death: Dec. 22, 1904
I Hereby Certify, that death occurred on the date stated above at.
To the best of my knowledge and belief cause of the death ws, viz.:
Chief Cause: Pneumonia
Signed: H.N. Mays, M.D.
[NOTE: Not sure if the right Anthony Ivins that was married to Clomenia Pratt.]