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Case File: Mailahn Family (1912)
From Death Records of Outagamie County, Wisconsin – Vol 3 (Pre Oct 1907)
Certificate No 168 (02024)
[Link to original on Ancestry.com]
| # | Question | Answer |
| 1 | Full name of deceased | Miss Vina Mailahn |
| 2 | Maiden name (if wife or widow) | [blank] |
| 3 | Color and sex | white – female |
| 4 | Race | Caucasian |
| 5 | Occupation of deceased | Housework |
| 6 | Age (years, months and days) | 23 yrs, 0 mos, 20 dys |
| 7 | Name of father | Louie Mailahn |
| 8 | Birthplace of father | Germany |
| 9 | Name of mother | Gusta Mailahn |
| 10 | Birthplace of mother | Dodge Co. |
| 11 | Birthplace of deceased | Black Creek |
| 12 | Date of birth of deceased | May 13 – 1884 |
| 13 | Condition (single, married, widowed, or divorced) | single |
| 14 | Name of wife or husband of deceased | [blank] |
| 15 | Date of death | June 14, 1907 |
| 16 | Cause of Death {Primary, Secondary} | Tuberculosis of Lunge |
| 17 | Duration of disease | about one year |
| 18 | Place of death | Center |
| 19 | Resident at time of death | Center |
| 20 | Was deceased ever a U.S. soldier or sailor | No |
| 21 | Name of physician, coroner or justice | J. J. Laird |
| 22 | Residence of such person | Black Creek, Wis. |
| 23 | Name of undertaker or other person conducting burial | Strassburger |
| 24 | No. and date of burial permit | 7 – |
| 25 | Place of burial | Black Creek Town Cem. |
| 26 | Date of certificate | June 14, 1907 |
| 27 | Date of registration | Jul 2, 1907 |
| 28 | Other important facts not related | [blank] |
