Date:  16 October 1953
Cert:  21109 
Place of Death: County: Knott      City or Town: Mousie  Rural
Length of stay (in this place): (blank)
Street address or location:  Died at home
Usual Residence of Deceased: State: Ky.     County: Knott
City or Town: Mousie Rural  If rural give location: on Jones Fork
Full Name:  Sarah Jane CONLEY
Date of Death:  16 October 1953
Sex, Color or Race, Marital Status: Female, White, Widowed
Date of Birth:  June 1869
Age:  84 years
Usual Occupation:  Housewife
Kind of Industry or business: (blank)
Birthplace:  Knott Co., Ky.
Father's Name:  (blank)
Mother's Maiden Name:  Liza HICKS
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  Hager WATTS
Disease/condition directly leading to death: Cerebral Hemorrhage
Interval between onset and death:  (blank)
Due to:  (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy:  (blank)
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from (blank) to (blank), that I last saw the deceased alive on (blank), and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  24 October 1953
Address:  Lackey, Ky.
Signature:  C. M. Aker, M.D.
Burial, Cremation or Removal:  Burial
Date:  18 October 1953
Name of Cemetery or Crematory:  Conley Cemetery
Location:  Mousie, Ky.
Date received by local registrar: 09 November 1953
Registrar's Signature:  Rose B. Craft
Funeral director & address:  John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 07 February 2011