Death Record
Certified Copy of Death Certificate
1. Name of Deceased: Martha Jane Clawson
2. Place of Death; A. County; Lane
B. City, Town of Location: Leaburg
C. Length of Stay in Years: 54 years
D. Name of Hospital or Institution: Pvt. Residence
3. Usual Residence; A. State: Ore
B. County: Lane
C. City, Town or Location: Leaburg
D. Street Address, Rural Route, Etc.:
4. Date of Death: Nove. 6, 1956
5. Sex: Female
6. Color or Race: White
7. Marital Status: Widowed
8. Social Security No.: None
9. Usual Occupation: Home Keeper
10. Kind of Business or Industry: At Home
11. Name of Spouse: William F. Clawson
12. Date of Birth: Feb. 9, 1872
13. Age Last Birthday: 84
14. Birthplace: Clarkville, Indiana
15. Was Deceased a Citizen of: U.S.
16. If Deceased was a Veteran, what War: None
17. Name of Father: Emanuel Stern
18. Maiden Name of Mother: Nancy Caylor
19. Informant's Name and relationship to Deceased: John Wilt - son/s/ DJR
20. Cause of Death;
Part I: Death was Caused by:
Immediate Cause (A): Congestive right heart failure; interval between Onset and Death: 2 years
Due to (B): Arteriosclerotic heart disease
Due to (C): arteriosclerosis
Part II: Other Significant Conditions contributing to Death but not related to the terminal diseases or condition given in Part I (A): Senility
21. If deceased was female, was therea pregnancy in the past 12 months: No
22. Was an autopsy performed: No
23. Was death result of (none of these are checked) accident, suicide, homicide
24. If Accident, did injury occur (not an accident, nothing checked)
25. Place of injury (this is also non-applicable)
26. Time of injury
27. Describe how injury occurred
28. Certficate: I certify that I (attended) (Investigated the death of) the deceased from or on June 1954 to Nov. 6, 1956 and that the death occurred at 6:50 pm from the causes and on the date listed above. W.E. Baldwin (signature) MD Springfield, Oregon 11-7-56
30A. Deceased was: buried
30B. Date: 11-10-56
30C. Name of Crematory or Cemetery: Greenwood Cemetery
30D. Location: Leaburg, Oregon
31. Date Received by Local Registrar: 11-8-1956
32. Registrar's Signature: /s/ Mayme Hackett, Dep.
33. Funeral Director's Signature and address: /s/ Derrel J. Rose, Springfield, Oregon
State of Oregon
County of Lane
This certifies that the foregoing is a correct and complete transcript of a record of death on file with the Oregon State Board of Health.
(signature) Harold J. Osterud M.D. registrar of vital statistics
By Mayme Hackett, Deputy (signature)
Date November 8, 1956
(The Seal has been imprinted onto this certificate)

Remembrance Card
In Memory of
MARTHA JANE CLAWSON
Date of Birth
February 9, 1872
Passed away
November 6, 1956
Services At
Buell Chapel
November 10, 1956
Rev. Clifford R. Alsen
Officiating
Jack Naff, Soloist
Vernice Cook, Organist
Interment
Greenwood Cemetery
Darrel J. Rose
Funeral Director