The handwritten entries are in blue; my comments are [bracketed]:
Physician's Certificate of Death-Issued by State Board of HealthState of Illinois, Cook County
The Physician who attended any person in a last illness should immediately return this Certificate, accurately filled out, to the County Clerk, if the party deceased died outside the limits of the City of Chicago; all deaths inside the city limits should be returned on these blanks to the
City Board of Health
1. Name: James M. Adsit
2. Sex: M Color: W
3. Age: 85 years 6 months 30 days [Calculated birth date is February 5, 1809]
4. Occupation: Banker
5. Date of Death: Sept. 4th 2:30 AM 94 
7. Nationality and place where born: Spencertown, N.Y. American [In Columbia County, N.Y.]
8. How long resident in this State: 56 years
9. Place of Death: 400 Dearborn Ave St. 24 Ward
10. Cause of death: Cerebral Hemorrhage [no entry under Complications]
11. Duration of disease: About 8 days
12. Place of Burial: Graceland
13. Name of Undertaker: C. H. Jordan + Co.
14. Dated at Chicago Sept 4th 1894. (Signature:) Frank Billings M.D.
Residence: 45-22nd St.
|1894 Chicago Directory, p. 228; Fold3.com|
I like to confirm the signature by looking up the physician's name in the city directory.
See his wife's death certificate here.
See a brief biography of James M. Adsit, First Chicago Banker, published in 1899 here.
I am descended from James M. Adsit as follows:
James Monroe Adsit
Charles Chapin Adsit
Charles McAlpin Pyle, Jr.