1. PLACE OF DEATH:  Fairfield, Wayne Co

2. PLACE OF RESIDENCE:  Wayne Co., IL

3. FULL NAME:  Isabell HUMPHREY 
    MAIDEN NAME: SIMMS
    PREVIOUS NAMES: OVERALL

4. SEX:  Female

5. RACE:  White

6. (a) MARTIAL STATUS: Widowed
    (b) SPOUSE: Levi HUMPHREY

7. BIRTH DATE OF DECEASED:  4 March 1861

8. AGE:  82 years, 11 months, 21 days

9. BIRTH PLACE:  Wayne County, Illinois

10. USUAL OCCUPATION:  Housewife

11. INDUSTRY OR BUSINESS:  Own Home

12. FATHER’S NAME:  William SIMMS

13. BIRTHPLACE:  England

14. MOTHER’S NAME:  Mary SIMMS [Maiden]

15. BIRTHPLACE:  England

16. INFORMANT:  R. W. BARINGER, 1511 Ashland, Harvey, Illinois

17. (a) PLACE OF BURIAL:  Maple Hill, Fairfield, Wayne County, Illinois
      (b) DATE:  27 February 1944

18-19.  N/A

20. DATE OF DEATH:  25 February 1944, 7:15 a.m.

21. IMMEDIATE CAUSE OF DEATH: Carcinoma Right Breast

22. OPERATION PERFORMED: No
       AUTOPSY: No

23. N/A

24. SIGNED:  J. D. BOGGS M.D., 
                          Fairfield, IL, 
                          26 February 1944