Notes for Infant Bushman: Full Name: _________ Bushman Sex: Boy Color: White Date of Birth: May 30, 1912 Birthplace: Carroll County Name of Father: C. Bushman . Birthplace of Father: Germany Maiden Name of Mother: Seeden Birthplace of Mother: Germany Occupation: Farmer Date of Death: May 30, 1912 IHEREBY CERTIFY THAT I attended deceased from May 30, 1912 to May 30, 1912 that I saw him alive on May 30, 1912 and that death occurred on the date stated above at 1:#0 p.m. THE CAUSE OF DEATH was as follows: Premature birth six months J.A. Downs May 31, 1912, Gidden, Iowa
PLACE OF BURIAL: West Liberty Cemetery DATE OF BURIAL: May 31, 1912
Infant Bushman (b. 30 May 1912, d. 30 May 1912)
Notes for Infant Bushman: