George H. Bruce

CERTIFICATE OF DEATH
OKLAHOMA STATE BOARD OF HEALTH
BUREAU OF VITAL STATISTICS
OKLAHOMA CITY, OKLAHOMA

Registration Dist. No. 10
Primiary Dist. No.

1. PLACE OF DEATH.
County Canter
Township or
Village or
City Ardmore
No. 419
Street N-Ware
Ward 1

2. FULL NAME of decedent if an unnamed child the surname, preceded by "unnamed"
George H. Bruce

Personal and Statistical Particulars
3. Sex Male
4. Color or Race, as white, black, mulatto (or other negro decent) Indian, Chinese, Japanese or other. White
5. Single, Married Widowed or Divorced Married
6. DATE OF BIRTH April 23 1841
7. AGE 77 yrs 10 mos 30 days
8. OCCUPATION Clerical work
9. BIRTH PLACE Vermont
PARENTS
10. NAME OF FATHER David Bruce
11. BIRTH PLACE OF FATHER
12. MAIDEN NAME OF MOTHER Sturdvant
13. BIRTH PLACE OF MOTHER

14. The above is true to the best of my knowledge
Informant Mrs. Geo. H. Bruce
Address Ardmore
15. Filed ________ 191_____
________________________Registrar.

Medical Certificate of Death.
16. DATE OF DEATH Mar. 20, 1919
17. I HEREBY CERTIFY that I attended deceased,
From Jan. 15, 1919, to Mar 20, 1919
that I saw him alive on Mar 20, 1919
and that death occurred on the date stated above at
_______________________m.
THE CAUSE OF DEATH *Was as follows:
Organic heart trouble
(Duration) — yrs. 2 mos. — days
Contributory Rheumetism (Secondary)
(Duration) 2 yrs. — mos. — days
(Signed) J. L. McNus M.D.
April 2, 1919 (Address) Ardmore
*State the disease causing death or, in deaths from violent causes; state (1) means of injury, and (2) whether accidental, suicidal or homicidal; state whether attributed to dangerous or insanitary condition of employment.
18. LENGTH OF RESIDENCE (for Hospitals, institutions, Transients or Recent Residents.)
At place of death ____ yrs., ____ mos., ____ days.
In the State ______yrs. ______ mos. ______ days
Where was disease contracted, if not at plcae of death?
Former or usual residence. [Lame]
19. PLACE OF BURIAL OR REMOVAL Rose Hill Date of Burial Mar 21, 1919
20. UNDERTAKER [Drielum] Address Ardmore