Transcribed by Alexander Conrad from a photocopy of the original.
State Department of Health of New Jersey
1. Place of Death
County: Burlington
Township: Medford
Length of stay: 1 year
Address: Berlin Rd. Taunton Lakes
2. Usual Residence
County: Burlington
Township: Medford
Address: Berlin Rd. Taunton Lakes
3. Name of Deceased: Olivia R. Todd
4. Date of Death: 12-7-55
5. Sex: Female
6. Color or Race: white
7. Marital status: widow
8. Date of Birth: 10-8-1869
9. Age (in years last birthday): 86
10: Usual occupation: none
11. Birthplace: Phila. Pa.
12. Citizen of What Country: USA
13. Father’s Name: Charles T. Moore
14. Mother’s Maiden Name: Lucy Ogle
15. Was the Deceased Ever in the U.S. Armed Forces? No
17. Informant: James Davidson – Taunton Lakes, NJ [son-in-law]
[Cause of death information redacted as per N.J.A.C. 8:2A-2.1]
22. I hereby certify that I attended the deceased from Sept 15, 1955 to Dec 7, 1955, that I last saw the deceased alive on Dec 6, 1955, and that the death occurred at 9:05 am, from the causes and on the date stated above.
23a. [signature]
23b. Address: Marlton, NJ
23c. Date Signed: 12/7 55
24a. Burial, Cremation, Removal: Burial
24b. Date: 12-10-55
24c. Name of Cemetery or Crematory: North Cedar Hill Cem.
24d. Location: Phila. Pa.
Date Rec’d by Local Reg.: 12-7-55
Registrar’s Signature: [signed by Harry Brick]
25. Funeral Director’s Signature
[last name Hoel?]
NJ Licence No. 441
Address: 811 Cooper St., Camden, NJ
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Original Source Citation:
New Jersey, State Department of Health, death certificate no. 48811 (1955), Olivia R. Todd; Office of Vital Statistics and Registry, Trenton.
