DEATH CERTIFICATE

CHARLOTTA BOLEN

Date 30 March 1912
Deathvol
Vol:   1912
Cert: # 16163
Name: Charlotta BOLEN
Female, White, Married
Age: 38 years, 22 months, 28 days
Place of Death: Voting Pct Lackey, Jones Fork, Knott Co., KY
Birth Date: 2 October 1873
Place of Birth: KY
Father: Isaac HIX                                                         Birthplace Father: KY
Mother: Susanna PRIDEMORE                                      Birthplace Mother: KY
Informant: Not Listed
Death Date: 30 March 1912
Cause of Death: Tuberculosis of lungs
Signed:   M.V. Wicker, M.D.
Burial Place: Hix Graveyard
Undertaker: Monroe Bolen
File Date: 01 August 1912
Transcribed by Debbie Tamborski, 13 June 2008