| Decedent's Given Name | John |
Emery | Decedent's Surname |
| Location | Grant Twp |
203 | Enumeration District |
| Enumerator | Charles W. Minkler |
63 | Family Number |
| Age | 8/12 |
M | Sex |
| Color | W |
| Marital Status |
| Birth Place | Iowa |
Penn | Father's Birth Place |
| Mother's Birth Place | Penn |
| Occupation |
| Month of Death | Apr |
Scarlet Fever | Cause of Death |
| How long in Story Co. | |
| Where illness contracted |
| Attending Physician | Beverly |
| Physician's Statement - Primary Cause |
| Physician's Statement - Immediate Cause | |
| Physician's Signature |
| Enumerator Remarks: | |
The following is not taken from the schedule. See the introduction for an explanation of sources.
| Birth Date | Aug 1879 |
Apr 1880 | Death Date |
| Head of Household Given Name | Amanda |
Emery | Head of Household Surname |
| Grave Marker in Story Co.? | No |
| Cemetery |
| Grave Marker Information: | |
| Transcriber Comments: | |