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DEATH
CERTIFICATE
ELMER RAY CASEBOLT
Date 24 March 1920
Cert: 09123
Place of Death: Voting Precinct: McRoberts, Letcher Co.,
Ky.
Full Name: Elmer Ray CASEBOLT
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 27 July 1916
Age: 04 years, 07 months, 27 days
Occupation: (blank)
Birthplace: Knott Co., Ky.
Name of Father: Silas CASEBOLT
Birthplace Father: Perry Co., Ky.
Maiden name of Mother: Ida DRAUHAN
Birthplace Mother: Knott Co., Ky.
Informant/Address: Silas CASEBOLT, McRoberts, Ky.
Filed: 25 March 1920
Registrar: M. G. Abbott
Death Date: 24 March 1920
I hereby certify that I attended deceased from 18 March 1920, to
23 March 1920, that I last saw him alive on 23 March 1920, and
that death occurred, on the date stated above, at 6:30 a.m.
Cause of Death: Broncho pneumonia and laryngitis
Duration: 04 days
Contributory: Measles
Signed/Address: H. B. Skaggs, M.D., 24
March 1920, McRoberts, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Moussey, Ky.
Date of Burial: 26 March 1920
Undertaker/Address: Family, McRoberts
Transcribed by Debbie Tamborski, 06 March 2010 |
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