| 1. Place of Death |
County Jackson Township Kan City Kans City No 4621 Mercer St
Registration District No. 899 Primary Registration District No. 1002 File No. 14492 Registered No. 1398 |
| 2. Full Name | David Mobray [sic] Bray |
| 3. Sex | M |
| 4. Color or Race | W |
| 5. Single Married Widowed or Divorced | Married |
| 6. Date of Birth | Aug 25, 1871 |
| 7. Age | 44 yrs 6 mos 15 ds |
| 8. Occupation | Restaurant Keeper |
| 9. Birthplace | England |
| 10. Name of Father | D P Bray |
| 11. Birthplace of Father | England |
| 12. Maiden Name of Mother | Emma Mobray [sic] |
| 13. Birthplace of Mother | England |
| 14. The above is true to the best of my knowledge | Ottie M Bray 4621 Mercer |
| 15. Filed | Apr 10 1916 Paul Capuen? Registrar |
| 16. Date of Death | Apr 10 1916 |
| 17. I hereby certify |
that I attended deceased from Nov 12 1915 to April 10 1916,
that I last saw him alive on April 9, 1916, and that death occurred on the date stated above, at 6 a.m. The cause of death was as follows: Cancer of the Bladder C.J.E. Easvaus? M.D. April 10 1916 710 ??? St |
| 18. Length of residence |
At place of death 3 mos.
In the State 20 yrs. Former or usual residence Kingsvill Mo |
| 19. Place of Burial or Removal | Forest Hill Apr ?? 1916 |
| 20. Undertaker | Mrs C L Forster |
Source: Missour Digital Heritage