The handwritten entries are in blue:
Bureau of Vital Statistics.
Department of Health: City of Chicago.
Undertaker's Report of Death.1. Name of Deceased (in full): Mrs. Arville S. Chapin Adsit
2. Sex: M [sic: s/b F] Color: W
3. Place of Birth: Mass. Father's Birthplace: N.Y. Mother's Birthplace: Mass.
4. Age: 85 Years 11 Months - Days
5. Lived in Illinois 65 Years, in Chicago: 65 Years
6. Died on the 6th Day of May 1906 at about 3:45 A.M.
7. Widowed. Occupation: None
8. Place of Death: 400 Dearborn Ave Ward: 21st
9. Place of Burial: Graceland
Date of Burial: May 8, 1906
Hour: 2:30 P.M.
10. Undertaker: C. H. Jordan + Co. Address: 14 E. Madison St. Tel. C1604 License No. 51
Physician's Certificate of Cause of DeathImmediate and Determining: Hypostatic Pneumonia Duration of Cause: 6 Days
Contributing Cause or Complication: Cerebral Haemorrhage, arteriosclerosis Duration of Cause: 8 months, 14 Days
|1906 Chicago Directory, p. 2909, Fold3.com|
Address: 15 Bellevue Place Tel.: North823
Previous posts about this second great grandmother of mine can be found at:
Chapin Family Sampler
And you can see her gravestone in Graceland Cemetery at Find A Grave.