DEATH CERTIFICATE

SAM EVERSOLE

Date    03 September 1911
Deathvol Vol:   1911
Cert: # 24260
Name: Sam EVERSOLE
Male, White, Single
Age: 2 months
Place of Death: Voting Pct. No. 8, Perry Co., KY
Birth Date: 03 July 1911
Place of Birth: Kentucky
Father: Alvin EVERSOLE                                                     Birthplace Father: Ky.
Mother: Polly COMBS                                                      Birthplace Mother: Ky.
Informant: Alvin EVERSOLE
Death Date: 03 September 1911
Cause of Death: Croup
Signed:  Not Listed
Burial Place: Not Listed
Undertaker: Not Listed
File Date: 15 September 1911
Transcribed by Debbie Tamborski, 24 June 2008