This week's document that I have chosen to transcribe is the death certificate of Tosten A, Brekke. I felt it was the ideal document as in recent Ed's Day Wednesday articles we have been learning about Tosten, who was my late cousin Edwin J. Ostrom's father's mother's father, or Ed's great-grandfather.
I am also excited to share this document with you as it is the first two-sided death certificate that I have run across. This is a fill-in-the-blanks form with the added information being handwritten. I will show the added information in bold, italics, blue font. My comments will be surrounded in square-brackets [ ].
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| IMAGE: Front of death certificate #5117, issued to Tosten A. Brekke in 1940. |
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| IMAGE; Back of death certificate issued to Tosten A. Brekke (1940). |
-------- transcription begins --------
[FRONT OF DOCUMENT]
[printed along the left margin]
MARGIN RESERVED FOR BINDING
R.L. [hand-stamped]
N.B.—WRITE PLAINLY, WITH UNFADING INK—THIS IS A PERMANENT RECORD, Every item of information should be carefully supplied. AGE should be stated EXACTLY. PHYSICIANS should state CAUSE OF DEATH in plain terms, so the it may be properly classified. Exact statement of OCCUPATION is very important.
========================================
4X18—1-19-37 5M Bks.
[printer's union label & circled 1]
Social Security No. of Deceased [blank] Age of Husband or Wife is Alive [blank] Years.
5117 [hand-stamped]
STATE OF MINNESOTA
Division of Vital Statistics
CERTIFICATE OF DEATH
Reg. District No. [blank] No. in Registration Book [blank]
(Above numbers to be filled in only by local registrar or his deputy.
1. PLACE OF DEATH
County Grant
Township [blank]
or
Village ELBOW LAKE
or
City [blank]
No. [blank] St. [blank] Ward
(If death occurred in a hospital or institutions, give the NAME instead of street and number.)
2. FULL NAME TOSTEN A. BREKKE
(Please PRINT names in capitals)
(2a) Residence. No. ELBOW LAKE, MINN St. [blank] Ward [blank]
(Usual place of abode.)
Length of residence in city or town where death occurred. 28 yrs. mos. ds.
How long in the U.S., if of foreign birth? 69 yrs. mos. ds.
3. SEX MALE
4. COLOR OR RACE WHITE
5. SINGLE, MARRIED, WID_OWED, OR DIVORCED (write the word) WIDOWED
5a. If married, widowed or divorced
HUSBAND of or WIFE of ANNIE STAVOS
6. DATE OF BIRTH JAN. 6, 1853
7. Age Years 87 | Months 2 | Days 26|
If LESS that 1 days, _hrs. or _min.
OCCUPATION
8. Trade, profession, or particular kind of work done, as engineer (type of) miners, sawyer, bookkeeper, etc
RETIRED FARMER
9. Industry or business in which work was done, as railway, mine (kind of) saw mill, bank, etc. [blank]
10. Date deceased last worked at this occupation (month and year) FALL 1912
11. Total time (years in the occupation LIFE
12. BIRTHPLACE (city or town) SAGN,
(State or Country) NORWAY
FATHER
13. NAME (Print) unknown
14. BIRTHPLACE (city or town)
(State or Country) NORWAY
MOTHER
15. MAIDEN NAME unknown
16. BIRTHPLACE (city or town)
(State or Country) NORWAY
17. INFORMANT John Brekke
(Address) Fergus Fall, Minn
18. BURIED AT OR REMOVED TO
Hjerdal Cem., Elbow Lake, Minn
Date. April 6, 1940
(Cremation—No. Yes
19. UNDERTAKER Loren W. Erickson
(Address) Elbow Lake, Minn
20. Filed 4-8-1940 Harry E. Sletten Registrar. APR 8, 1940 [rubber stamped]
21. DATE OF DEATH (month, day, and year) April 2 1940
22. I HEREBY CERTIFY that I attended deceased from
did not attend
I last saw him dead in bed 4/2 1940; death is said to have
occurred sometime on the date stated above after midnight.
The PRIMARY UNDERLYING CAUSE of death
Probably cerebral hemorrhage Duration ü
Contributory causes of importance in order of onset:
(1)
(2) ü Duration ü
(3)
Did an operation precede death? no
If so, state condition for which was undertaken ü
Date of operation ü Was there an autopsy? no
23. If death was due to external causes (violence) fill in also the
following: Accident, suicide, or homicide.ü Date of injury ü19_
Manner of injury Nature of injury ü
24. Was disease or injury in any way related to occupation ü of deceased? no
If so, specify ___
(signed) E. T. Reeve, M.D.
4/3, 1940 (Address) Elbow Lake Coroner
[printed along the right-hand margin]
Received April 3, 1940 Loren W. Erickson Sub-Registrar
=========================================
[BACK OF DOCUMENT]
[printed along left-hand margin, page rotated 90 degrees from front]
ADDITIONAL SPACE FOR FURTHER STATEMENTS BY PHYSICIAN
[at top of document]
MARGIN RESERVED FOR BINDING
============================================
He died some time after midnight April 2- His care taker saw him at midnight, gave him something to eat and fixed his fire- When he came back about 8:00 A.M. to give him his morning care he was dead.
He had a slight cerebral hemorrhage about three months ago. Death occurred some time after midnight.
[signed] E.T. Reeve M.D.
G.C. [rubber-stamped]
-------- transcription ends --------
Source:
1.) Minnesota, Division of Vital Statistics, death certificate 5117 (1940), Tosten A. Brekke, from the family files of Edwin J. Ostrom, held by Darlene Steffens [ADDRESS FOR PRIVATE USE].
Amanuensis Monday is a weekly blog theme that was started by John Newmark, the author of TransylvanianDutch blog. John defines Amanuensis as "A person employed to write what another dictates or to copy what has been written by another." I also appreciate the good work and format examples of San Diego genealogist Randy Seaver of the blog Genea-musings. Thanks guys.
Transcribing helps me to learn what a document contains. I have learned over time that I have a tendency to "skim" over an item; a bad trait for a researcher who needs to learn even the smallest details documented records contain. Transcribing helps me to slow down and "smell the roses," and to capture all aspects of the paper in hand. It also gives me a better opportunity to share the document with you.
I hope you enjoyed seeing this document and that you have a good week. Thank you for joining me here.
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The URL for this post is: http://homefolktales.blogspot.com/2017/03/amanuensis-monday-death-certificate-for.html
Please comment regarding this post on the website by clicking the URL above and then use the "Comments" link at the bottom of each post. Or contact me by email at dsteff4246[at]gmail[dot]com. Thank you.
Copyright (c) 2017, Darlene M. Steffens
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