Death Certificate of Simon Wasserstein, 1909 January 6
Death certificate of Simon Wasserstein from the state of Colorado. Information on the form includes age, sex, date of birth, marital status, birthplace, occupation, information on relatives, date of death which is "Jan 6th, 1909," Cause of death listed as Pulmonary tuberculosis, signed by J. B. Fish January 6, 1909 in Edgewater, Colorado. States filed January 11, 1909 by J. L. Davidson. Place of burial listed as "Rose Hill Cemetary," date of burial was January 8, 1909. The back of the form states that it is certifying the death certificate of Simon Wasserstein, signed in ink by J. L. Davidson.
- 1909 January 6
- Davidson, J. L. (Producer, Person)
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1 items (death certificate)
Scope and Contents
From the Series: This series of patient records includes medical reports and histories, statistical data of patients, x-rays, and death certificates. The patient files include applications, correspondence and some may also contain photographs and personal items.
Materials Specific Details
Top left corner stamped in black ink "Jefferson County." Top left corner handwritten in pencil "928" which is Simon Wasserstein's JCRS patient number. On the back of the form, handwritten in ink "Kindly return this."
Title supplied by archivist.