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DEATH
CERTIFICATE
SALLIE BACH
Date 21 October 1912
Cert: 03107
Place of Death: Voting Precinct: Stevenson, Ky.,
Breathitt Co.
Full Name: Sallie BACH
Sex, Color or Race, Marital Status: Female, White,
Widowed
Date of Birth: unknown
Age: about 70 years
Occupation: House work
Birthplace: Knott Co., Ky.
Name of Father: Mr. CORNETT
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: unknown
Birthplace Mother: unknown
Informant/Address: Wilgus BACH, M.D., Jackson
Filed: 10 (illegible) 1913
Registrar: J. L. (illegible)
Death Date: 21 October 1912
I hereby certify that I attended deceased from January 1912, to
October 1912, that I last saw her alive on September 1912, and
that death occurred, on the date stated above, at 10 a.m.
Cause of Death: Cardiac Insufficiency
Duration: (blank)
Contributory: Asthma
Signed/Address: Wilgus Bach, 21 October 1912, Jackson
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 24 February 2010 |
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