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Death ID: Certificate Location: Certificate Number: Death Location: Death Address: Death Date: Informant: Decedent Name: Immigrant ID: Sex: Marital Status: Age (Birth Date): Occupation: Home Address: Birth Place: Residence Years: Spouse Name: Immigrant ID: Father Name: Immigrant ID: Birth Place: Mother Name: Immigrant ID: Birth Place: Burial Place: Death Cause: acute heavy metal poisoning (probably bichloride of mercury) (suicide, drank poison in home)Comments: in community & state since 1921, in USA since 1920 / husband's age: 57 years