1 Place of Death

County:  Clark

Township:  Butler

Village: 

City: 

STATE OF WISCONSIN

Department of Health - Bureau of Vital Statistics

Original Certificate of Death

                                                Registered No: 

2 FULL NAME:  Bder Alworth Cole

Personal and Statistical Particulars

Medical Certificate of Death

3 Sex

M

4 Color

W

5 S/M/W/D

Married

16 Date of Death (M/D/Y)

Dec 15, 1942

6 Date of Birth (M/D/Y)

Jan 17, 1857

17 I HERBY CERTIFY, That I attended deceased from

May 1942 to Dec 1942

that I saw him     alive  on  15^th Dec 1942

and that death occurred on the date above, at 3 PM

The cause of death was as follows:

Cerebral hemorrhage, arth ?? selussis?

Signed:  Dr. W. C. Olson, M. D.

Date:  12/16/42     Greenwood

7 Age (Yrs/Mos/Ds/Hrs/Min)

85/10/28

8 Occupation

Farmer

9 Birthplace

Reedsburg, Wis.

10 Name of Father

Gelman Emery Cole

11 Birthplace of Father

Ohio

18 Length of Residence (Hospitals, etc.)

12 Maiden Name of Mother

Sarah Amanda Goss

13 Birthplace of Mother

Ohio

14 The above is true to the best of my knowledge

Informant:  Mrs. B. A. Cole

Address:  Thorp, Wis

19 Place of burial or removal

Greenwood, Wis.

Date

12/18/ 1942

15  File date - Registrar

20 Undertaker

T. F. Schuller

Address

Greenwood,

Wis