DEATH CERTIFICATE

SUSIE GRIGSBY

Date    05 September 1911
Deathvol Vol:   1911
Cert: # 24261
Name: Susie GRIGSBY
Female, White, Single
Age: 4 years
Place of Death: Voting Pct. No. 8, Perry Co., KY
Birth Date: September 1907
Place of Birth: Ky.
Father: Sam GRIGSBY                                                     Birthplace Father: Ky.
Mother: Sally EVERSOLE                                                      Birthplace Mother: Ky.
Informant: Not Listed
Death Date: 05 September 1911
Cause of Death: Membranous Croup
Signed:  G. C. Morgan, M.D.
Burial Place: Not Listed
Undertaker: Not Listed
File Date: 07 September 1911
Transcribed by Debbie Tamborski, 24 June 2008