| Full Name of Deceased |
George
Smith |
| Color |
white |
| Sex |
Male |
| Age |
5 years |
| Name of Father of Deceased |
|
| Name of Mother of Deceased |
|
| Occupation |
Laborer on R & R |
| Place of Birth |
U. S. |
| Name of Wife of Deceased |
|
| Name of Husband of Deceased |
|
| Date of Birth |
1872 |
| Date of Death |
June 28, 1877 |
| Cause of Death |
Scarlet fever |
| Name of place, town or township,
and county in which person died |
Peshtigo, Wis. |
| Name and location of burial
ground in which interned |
Peshtigo, Wis. |
| Name of person returning certificate |
L. J. Smith |
| Residence of such person |
Peshtigo |
| Date of Certificate |
June 28, 1877 |
| Date of Registration |
Oct. 13, 1877 |
| Other Information |
No Attendance |
|
| Full Name of Deceased |
Albertina
Smith |
| Color |
White |
| Sex |
Female |
| Age |
1 year |
| Name of Father of Deceased |
|
| Name of Mother of Deceased |
|
| Occupation |
|
| Place of Birth |
U. S. |
| Name of Wife of Deceased |
|
| Name of Husband of Deceased |
|
| Date of Birth |
June 1876 |
| Date of Death |
Feb. 23, 1877 |
| Cause of Death |
Scarlet fever |
| Name of place, town or township,
and county in which person died |
Peshtigo, Wis. |
| Name and location of burial
ground in which interned |
Peshtigo, Wis. |
| Name of person returning certificate |
L. J. Smith |
| Residence of such person |
Peshtigo, Wis. |
| Date of Certificate |
June 28, 1877 |
| Date of Registration |
Oct. 13, 1877 |
| Other Information |
No Medical Attendance |
|
|