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:  Ruth Ione Butler Shoemaker

Personal and Statistical Particulars

Medical Certificate of Death

3 Sex

Female

4 Color

White

5 S/M/W/D

16 Date of Death (M/D/Y)

Dec 31, 1928

6 Date of Birth (M/D/Y)

Jan 21, 1903

17 I HERBY CERTIFY, That I attended deceased from

Dec 19, 1928 to Dec 31, 1928

that I saw her     alive  on Dec 31 1928

and that death occurred on the date above, at 12:20 AM

The cause of death was as follows:

Pneumonia

Signed:  B.A. Cole, M.D.

Date: Dec 31, 1928   Thorp, Wis

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

25/11/10

8 Occupation

Housewife

9 Birthplace

Eau Claire, Wis.

10 Name of Father

W. C. Butler

11 Birthplace of Father

Wis.

18 Length of Residence (Hospitals, etc.)

12 Maiden Name of Mother

Minnie Brown

13 Birthplace of Mother

Wis.

14 The above is true to the best of my knowledge

Informant:  B. A. Cole, M.D.

Address:  Thorp, Wis

19 Place of burial or removal

Butler Cemetery

Date

Jan 2, 1929

15  File date - Registrar

20 Undertaker

John J. Bogumill

Address

Thorp, Wis