• back to BMD •
Julia Agnes (McManus) DeCoursey
(1882 - 1923)
| STATE OF KANSAS
State Board of Health � Division Vital Statistics |
STANDARD
CERTIFICATE OF DEATH |
205 16452 | |
Township___________ Registered No. 5331
or
City Kansas City Kans No. Providence Hospital St., _____Ward
(If death occurred in a hospital or institution, give its NAME instead of street and number)
2. FULL NAME: Julia Agnes DeCoursey
(a) Residence (Usual place of abode). No. 408 North 17th st. St., _____Ward.
Length of residence in city or town where death occurred __yrs. __mos. __ds.
How long in U.S. if of foreign birth? __yrs. __mos. __ds.
PERSONAL AND STATISTICAL PARTICULARS
3. SEX Female
4. COLOR OR RACE white
5. Single, Married, Widowed, or Divorced (write the word) married
5a. If married, widowed, or divorced HUSBAND of (or) WIFE of James H DeCoursey
6. DATE OF BIRTH (month, day, and year) _____________
7. AGE 39 Years ____Months ____Days
8. OCCUPATION OF DECEASED
(a) Trade, profession, or particular kind of work Housekeeper
(b) General nature of industry, business, or establishment in which employed (or employer) __________
(c) Name of employer __________
9. BIRTHPLACE (city or town) ___________ (State or country) Kansas
PARENTS
10. NAME OF FATHER Michael McMamus 1
11. BIRTHPLACE OF FATHER (city or town) _________ (State or country) Canada
12. MAIDEN NAME OF MOTHER Sarah Murray
13. BIRTHPLACE OF MOTHER (city or town) _________ (State or country) Ohio
14. Informant James H. DeCoursey
(Address) 408 North 17th st.
15. Filed MAR 28 1923 Howard Payne Registrar
MEDICAL CERTIFICATE OF DEATH
16. DATE OF DEATH (month, day, and year) Mch 27 , 19 23 ,
17. I HEREBY CERTIFY, That I attended deceased from Mch 26 , 19 23 , to Mch 27 , 19 23 , that I last saw h er alive on Mch 27 , 19 23 , and that death occurred, on the date stated above, at 11:00 A m.
The CAUSE OF DEATH * was as follows: Encephalitis 2 (duration) ___yrs. ___mos. 1 ds.
CONTRIBUTORY (Secondary) ___________ (duration) ___yrs. ___mos. ___ds.
* State the DISEASE CAUSING DEATH, or in deaths from VIOLENT CAUSES, state (1) MEANS AND NATURE OF INJURY, and (2) whether ACCIDENTAL, SUICIDAL, or HOMICIDAL. (See reverse side for additional space.)18. Where was disease contracted if not at place of death? ___________
Did an operation preceede death? No Date of ______
Was there an autopsy? No
What test confirmed diagnosis? Symtomology
(Signed) J. F. Hassig ,3 M.D. 3/29? , 19 23 (Address) Kansas City, Kans
19. PLACE OF BURIAL, CREMATION, OR REMOVAL St. John Cemetery
DATE OF BURIAL Mar 29th 19 23
20. UNDERTAKER Frank Galvin ADDRESS 1038 Minn Ave
1 Should be McManus, not McMamus. This was probably just a handwriting slip on James' part.
2 Encephalitis is an acute inflammatory process that affects brain tissue. The disease is most commonly caused by viral infection.
3 John F. Hassig, a doctor with his own general practice, is enumerated in the 1920 Federal Census living with his family at 339 North 17th St. in Kansas City. This was less than a block away from where James and Julia were living at number 408 on the same street.
