- Registered Number: 14840
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- 1. Place of Death: County of Cook, Registration District No. 3104
- City: Chicago, Street No. Ward: 31
Street and No. 1434 72nd Place
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- 2. Full Name: Frank Pajewski
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- 3. Sex: Male, 4. Color: White, 5. Marriage Status: Married
- 6. Date of Birth: March 15, 1866
- 7. Age: 51 Years 1 Months 3 Days
- 8a. Trade, profession, or particular kind of work: Carpenter
- 8b. General nature of industry or business, or establishment in which employed (or employer):
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- 9. Birthplace: Germany
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- 10. Name of Father: Don't Know
- 11. Birthplace of Father: Don't Know
- 12. Maiden Name of Mother: Don't Know
- 13. Birthplace of Mother: Don't Know
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- 14. Informant: Augustina Pajewski
- Address: 1434 72nd Place
- 15. Filed: 4-20-17
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- Medical Certificate of Death:
- 16. Date of Death: April 18, 1917
- 17. I hereby certify, that I attended deceased from April 15, 1917 to April 18, 1917, that I last saw him alive on April 18, 1917 and that death occurred, on the date stated above, at 3 P. M. The cause of death was as follows:
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- Pulmonary Tuberculosis 4 Years
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- Contributory (Secondary):
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- 18. Place of Burial: St. Marys
- 19. Date of Burial: April 21, 1917
- 20. Undertaker: Wm. G. Scharf Address: 5020 Ashland
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