Page 81 DATE: Oct. 22, 1930
NAME of DECEASED: __________ Shields [infant daughter]
SEX: Female COLOR: White
CHARGE TO: Glenn Shields ORDER GIVEN BY:
Date of Funeral: Oct. 22, 1930 Place of Death: Fayette Township [Decatur Co.]
Funeral Services at Time of Funeral Services: 2:30 P. M.
Certifying Physician: Dr. King His Residence: Lamoni
Cause of Death: Stillborn Date of Death: Oct. 22, 1930
Occupation of the Deceased:
Single, Married, Divorced: S Religion:
Aged: Birth Place: Fayette Twp., Decatur Co.
Father: Glenn Shields Birth Place: Mt. Ayr, Ia.
Maiden Name of Mother: Mary Wilcoxson Birth Place: Missouri
Informant: Glenn Shields Address: Lamoni, Iowa
Size and Style of Casket or Coffin: #150 White Plush; Cream twill
Manufactured by Roots
Interment at Maple Row Cemetery Lot or Grave No. old