Created by gpt-4o-2024-11-20 on 2025-06-12

This image depicts a blank death record form. It includes fields to document details about the deceased, such as:

• Name
• Place of Death (with "No." and "Street")
• Residence
• Birthplace
• Marital Status (options: Single, Married, Widowed, Divorced)
• Sex (options: Male, Female)
• Date of Death
• Age (broken down into years, months, and days)
• Color
• Occupation
• Father's Name and Father's Birthplace
• Mother's Maiden Name and Mother's Birthplace
• Disease or Cause of Death
• Place of Interment
• Physician and Undertaker
• Date received for record (including the year)
• Space for the signature of the Clerk

The form is structured, ruled with horizontal blue lines, and has "DEATH" labeled in the top-right corner. It was manufactured by "YAWMAN & ERBE MFG. CO., ROCHESTER AND BOSTON" and is marked with a reference number "3049 1000 S-12" at the bottom.

Created by gpt-4o-2024-08-06 on 2025-06-12

The image is a blank death certificate form. It is designed to collect information about a deceased person. The form includes fields for the following details:

• Name
• Place of Death (Number and Street)
• Residence
• Birthplace
• Date of Death (Year 19__)
• Marital status options (Single, Married, Widowed, Divorced) and sex (Male, Female)
• Color (presumably race or ethnicity)
• Occupation
• Age (broken down into years, months, and days)
• Father's Name
• Father's Birthplace
• Mother's Maiden Name
• Mother's Birthplace
• Disease or Cause of Death
• Place of Interment
• Physician
• Undertaker
• Received for record on the ___ day of _, 19
• Clerk

At the bottom, it is noted that the form is produced by "Yawman & Erbe Mfg. Co., Rochester and Boston," and has a reference number at the bottom right: "3049 1000 5-12."

Created by anthropic.claude-3-haiku-20240307-v1:0 on 2025-06-15

The image appears to be a death certificate or similar official document. It contains various fields to record details about a person's death, such as their name, place of death, residence, date of death, occupation, age, marital status, parents' information, cause of death, place of interment, and the attending physician and undertaker. The document seems to be a standardized form used for recording and documenting death-related information.

Created by us.anthropic.claude-3-5-sonnet-20241022-v2:0 on 2025-06-15

This is a blank death certificate form. It appears to be a historical document, likely from the early 1900s based on its design and formatting. The form includes various fields to be filled out, including:

• Name
• Place of Death and Street Number
• Residence and Birthplace
• Date of Death
• Marital Status (Single, Married, Widowed, Divorced)
• Gender (Male/Female)
• Color
• Occupation
• Age (in Years, Months, Days)
• Father's Name and Mother's Maiden Name
• Parents' Birthplaces
• Disease or Cause of Death
• Place of Interment
• Physician and Undertaker information
• Recording information and Clerk signature line

At the bottom of the form, there's a printer's mark indicating it was produced by "YAWMAN & ERBE MFG. CO., ROCHESTER AND BOSTON"

The form is printed with light green/blue lines and text on what appears to be aged, slightly yellowed paper.

Created by us.meta.llama3-2-11b-instruct-v1:0 on 2025-06-04

The image depicts a vintage death certificate, featuring a beige background with blue horizontal lines. The top-right corner displays the word "DEATH" in black text, while the bottom-left corner contains the text "YAWMAN & ERDE MFG. CO., ROCHESTER AND BOSTON."

The certificate is divided into sections, including:

• Name: Blank
• Place of Death No.: Street
• Residence: Birthplace
• Date of Death: 19
• Color: Occupation
• Age: Y.
• Father's Name: Mother's Maiden Name
• Father's Birthplace: Mother's Birthplace
• Disease or Cause of Death: *
• Place of Interment: Undertaker
• Physician: Received for record on the day of
• Clerk: 19

The certificate is printed on a beige card with blue horizontal lines, and the text is in black. The overall appearance suggests that it is an old document, likely from the early 20th century.

Created by us.meta.llama3-2-90b-instruct-v1:0 on 2025-06-04

The image presents a death certificate, featuring a beige background with blue horizontal lines and black text. The top-right corner displays the word "DEATH" in bold black letters.

Certificate Structure:

• The certificate is divided into sections, each containing specific information about the deceased individual.
• The sections are organized in a clear and concise manner, making it easy to read and understand the information provided.

Information Contained:

• Name: The name of the deceased individual is not filled in.
• Place of Death: The place of death is not specified.
• Residence: The residence of the deceased is not provided.
• Date of Death: The date of death is listed as 19, but the month and year are not specified.
• Color: The color or race of the deceased is not indicated.
• Occupation: The occupation of the deceased is not mentioned.
• Age: The age of the deceased is listed as Y, but the specific age is not provided.
• Father's Name: The father's name is not filled in.
• Mother's Maiden Name: The mother's maiden name is not specified.
• Father's Birthplace: The father's birthplace is not indicated.
• Mother's Birthplace: The mother's birthplace is not provided.
• Disease or Cause of Death: The disease or cause of death is not listed.
• Place of Interment: The place of interment is not specified.
• Physician: The physician's name is not filled in.
• Undertaker: The undertaker's name is not provided.
• Received for Record on the Day of: The date the certificate was received for record is listed as 19, but the month and year are not specified.
• Clerk: The clerk's name is not signed.

Additional Information:

• The bottom-left corner of the certificate features the text "YAWMAN & ERDE MFG. CO., ROCHESTER AND BOSTON."
• The bottom-right corner displays the numbers "3049 1000 5-12."

Overall, the death certificate provides a structured format for recording information about the deceased individual, but much of the information is not filled in.

Created by amazon.nova-lite-v1:0 on 2025-06-03

A death certificate is on a page. The certificate is titled "DEATH" at the top. Below the title, there are several lines of text with labels and blank spaces. The labels include "Name," "Place of Death No.," "Street," "Residence," "Birthplace," "Single," "Widow," "Male," "Date of Death," "Color," "Occupation," "Age," "Y.," "M.," "D.," "Father's Name," "Maiden Name," "Father's Birthplace," "Mother's Birthplace," "Disease or Cause of Death," "Place of Interment," "Physician," "Undertaker," "Received for record on the day of," and "Clerk." The blank spaces are left for the information to be filled in.

Created by amazon.nova-pro-v1:0 on 2025-06-03

The image is a death certificate form with various fields to be filled in. The form is titled "DEATH" at the top, indicating its purpose. The certificate is divided into several sections, each with specific fields to be completed.

The fields on the form include:

• Name: This is where the full name of the deceased is to be recorded.
• Place of Death No.: This field is for the number associated with the place of death.
• Street: This is for the street address where the death occurred.
• Residence: This field is for the usual residence of the deceased.
• Birthplace: This is where the birthplace of the deceased is recorded.
• Single/Married/Widowed/Divorced: This section is for indicating the marital status of the deceased.
• Male/Female: This field is for recording the gender of the deceased.
• Date of Death: This is where the date of death is recorded.
• Color: This field is for recording the race or ethnicity of the deceased.
• Occupation: This is where the occupation of the deceased is recorded.
• Age: This field is for recording the age of the deceased.
• Y. M. D.: This section is for recording the year, month, and day of birth of the deceased.
• Mother's Maiden Name: This field is for recording the maiden name of the deceased's mother.
• Father's Name: This is where the name of the deceased's father is recorded.
• Father's Birthplace: This field is for recording the birthplace of the deceased's father.
• Mother's Birthplace: This is where the birthplace of the deceased's mother is recorded.
• Disease or Cause of Death: This field is for recording the disease or cause of death.
• Place of Interment: This is where the place of burial or interment is recorded.
• Physician: This field is for recording the name of the physician who attended the deceased.
• Undertaker: This is where the name of the undertaker is recorded.
• Received for record on the day of: This section is for recording the date the certificate was received for record.
• Clerk: This field is for recording the name of the clerk who processed the certificate.

The form has horizontal lines dividing each section, and the fields are arranged in a structured format. The form is printed on paper with a light background, and the text is in black. The form is designed to be filled in by hand, with blank spaces provided for each field.

At the bottom of the form, there is a reference to "YAWMAN & ERDE MFG. CO., ROCHESTER AND BOSTON" and a series of numbers "3049 1000 5-12," which likely indicate the manufacturer and batch details of the form.

Created by gemini-2.0-flash on 2025-05-30

Here's a description of the image:

The image is a vintage death record form. The form is printed on light-colored cardstock and has horizontal lines for filling in information. The word "DEATH" is printed in the upper right corner in a large, bold, sans-serif font.

The form has fields for:

• Name
• Place of Death No.
• Street
• Residence
• Birthplace
• Date of Death
• Year
• Single
• Married
• Widowed
• Divorced
• Male
• Female
• Color
• Occupation
• Age
• Years
• Months
• Days
• Father's Name
• Mother's Maiden Name
• Father's Birthplace
• Mother's Birthplace
• Disease or Cause of Death
• Place of Interment
• Physician
• Undertaker
• Received for record on the day of
• Year
• Clerk

At the bottom left of the form is printed "YAWMAN & ERBE MFG. CO., ROCHESTER AND BOSTON".
At the bottom right of the form is printed "3049 1000 5-12"

Created by gemini-2.0-flash-lite on 2025-05-30

This is a vintage death certificate form. It's a rectangular card with horizontal blue lines for filling in information. At the top right, the word "DEATH" is printed.

The form includes fields for:

• Name
• Place of Death
• Residence
• Date of Death
• Color
• Occupation
• Father's Name and Birthplace
• Mother's Maiden Name and Birthplace
• Age
• Marital Status
• Gender
• Cause of Death
• Place of Interment
• Physician
• Undertaker
• Clerk

The bottom of the form indicates it was manufactured by "YAWMAN & ERBE MFG. CO., ROCHESTER AND BOSTON." The form also shows a series of numbers at the bottom.

Created by us.mistral.pixtral-large-2502-v1:0 on 2025-06-04

The image depicts a blank death certificate form. The form is titled "DEATH" at the top. It contains several fields to be filled out with information about the deceased individual. Here is a breakdown of the fields on the form:

1. Name: The full name of the deceased.
2. Place of Death No.: The identification number assigned to the place of death.
3. Street: The street address where the death occurred.
4. Residence: The usual residence of the deceased.
5. Birthplace: The place where the deceased was born.
6. Date of Death: The date on which the death occurred.
7. Marital Status: Options include Single, Married, Widowed, or Divorced.
8. Gender: Options are Male or Female.
9. Color: Presumably referring to race or skin color.
10. Occupation: The job or profession of the deceased.
11. Age: The age of the deceased at the time of death, specified in years (Y.), months (M.), and days (D.).
12. Father's Name: The full name of the deceased's father.
13. Father's Birthplace: The place where the deceased's father was born.
14. Mother's Maiden Name: The full maiden name of the deceased's mother.
15. Mother's Birthplace: The place where the deceased's mother was born.
16. Disease or Cause of Death: The medical condition or cause leading to the death.
17. Place of Interment: The location where the deceased will be buried or interred.
18. Physician: The name of the physician who attended to the deceased or confirmed the death.
19. Undertaker: The name of the undertaker or funeral director handling the arrangements.
20. Received for record on the day of: The date on which the death certificate was received for official record.
21. Clerk: The name of the clerk who received the death certificate for record.

At the bottom of the form, it is noted that the form was manufactured by Yawman & Erbe Mfg. Co., located in Rochester and Boston. The form number is 3049, and it is dated 5-12.