| Decedent's Given Name | Carrie |
Severtson | Decedent's Surname |
| Location | Palestine Twp |
209 | Enumeration District |
| Enumerator | A.K. Webb |
| Family Number |
| Age | 1/12 |
F | Sex |
| Color | W |
Single | Marital Status |
| Birth Place | Iowa |
Norway | Father's Birth Place |
| Mother's Birth Place | Norway |
| Occupation |
| Month of Death | Apr |
P.R. Chd infton | Cause of Death |
| How long in Story Co. | 1/12 |
| Where illness contracted |
| Attending Physician | |
| 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 | Mar 1880 |
Apr 1880 | Death Date |
| Head of Household Given Name | |
| Head of Household Surname |
| Grave Marker in Story Co.? | No |
| Cemetery |
| Grave Marker Information: | |
| Transcriber Comments: | |