DEATH CERTIFICATE

CLINTON COMBS

Date 22 January 1913
Cert: 00560
Place of Death: Vot. Prec.: No. 1, Jackson, Breathitt Co., KY
Full Name: Clinton COMBS
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 09 December 1895
Age: 17 years, 01 months, 13 days
Occupation: None
Birthplace: Knott Co., Ky.
Name of Father: Cooly COMBS
Birthplace Father: Perry Co., Ky.
Maiden name of Mother: Cordelia JOHNSON
Birthplace Mother: Knott Co., Ky.
Informant/Address: (illegible), Jackson, Ky.
Filed: 10 February 1913
Registrar: (illegible)
Death Date: 22 January 1913
I hereby certify that I attended deceased from 19 December 1912, to 07 January 1913, that I last saw him alive on 07 January 1913, and that death occurred, on the date stated above, at 9 a.m.
Cause of Death: Tuberculosis of the lungs
Duration: about 03 years
Contributory: relapse on measles
Signed/Address: (illegible) 22 January 1913, Jackson, Ky.
Length of residence at place of death: 06 years
Length of residence in the state: 17 years, 01 month, 13 days
Where was disease contracted: Perry Co., KY
Former or Usual residence: Perry Co., KY
Place of Burial or Removal: Jeff, Perry Co., Ky.
Date of Burial: (illegible) January 1913
Undertaker/Address: Cooly Combs, Jackson, Ky.
Transcribed by Debbie Tamborski, 24 February 2010