DEATH CERTIFICATE: Washington State Board of Health, Bureau of Vital Statistics, Certificate of Death. Record #268. Registered #10. LDS microfilm #0196600.
NAME OF DECEASED: Samuel W Moore
Date of Death: 9 September 1923
Place of Death: Doty Twp., Lewis Co., Washington
Resident No.: Doty Wash How Long a resident: 12 years
Spouse: Jennie Moore
Date of Birth of Deceased: February 17, 1848
Age at Death: 75 years, 6 months, 23 days
Occupation of Deceased: Farmer, Retired
Birthplace of Deceased: West Virginia
Name of Father: Jim Moore Birthplace of Father: West Virginia
Name of Mother: Unknown Birthplace of Mother: Unknown
Place of Burial: Dryad Cemetery Date of Burial: 11 September 1923
Undertaker: Sticklin Und Co., Chehalis
Informant: Simon Moore, Doty Washington
Medical Certificate of Death:
Date of Death: September 9, 1923
I hereby certify, that I attended deceased from January 1923 to September 10, 1923. that I last saw him alive on September 9, 1923, and that death accrued on the sate stated above at 6 pm.
Primary cause of death was Arterial Sclerosis which he had for several years.
Contributory cause was Apoplexy which he had for several years.
Transcribed by Constance Diamond. Samuel Moore was her great-grandfather. See also his obituary.