REGISTRATION OF DEATHS

NEILLSVILLE CLARK CO., VOL 1, 1870-1879, (pg. 7)

1. Full name of deceased: Vernam, John
2. Color: White
3. Sex: M
4. Age: 72
5. Name of the father of deceased:
6. Name of the mother of deceased:
7. Occupation: Farmer
8. Place of Birth: Boulton, Warren Co., NY
9. Name of wife of deceased: Clarisie
10. Name of husband of deceased:
11. Date of birth and date of death: Mar. 24, 1874
12. Cause of death: Apoplexy
13. Name of the place,
town or township, and county,
in which the person died:
14. Name and location of burial ground
in which interred: Town of Weston, Clark Co., WI
15. Name of person returning certificate: J. C. Lacey, Jr.
16. Residence of such person: Neillsville, Clark, WI
17. Date of certificate: Mar. 24, 1877
18. Date of Registration: Apr. 14, 1877

Transcribed by Janet.