STATE OF UTAH—DEATH CERTIFICATE
| County of Death | Davis
|
| Township of Death | Farmington |
| Full Name | Mary S Clark |
| Sex | Female |
| Color or Race | White |
Single
Married
Widowed
Or Divorced | Widow |
| Date of Birth | Aug 29, 1825 |
| Age | 86 years 2 months 24 days |
| Occupation | House Wife |
| Birthplace (State or Country) | England |
| Name of Father | Joseph Stevensen |
| Birthplace of Father (State or Country) | England |
| Maiden Name of Mother | Elizabath Stevensen |
| Birthplace of Mother (State or Country) | England
|
| Date of Death | November 24, 1911 |
| Cause of Death | Ruptured Appendix causing general peritonitis. |
| Informant | Joseph S. Clark |
| Informant Address | Farmington |
| Place of Burial | Farmington |
| Date of Burial | Nov. 28, 1911 |
