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DEATH
CERTIFICATE
JANE JACKSON
Date 11 October 1912
Cert: # 5730
Name: Jane JACKSON
Female, Black, Single
Age: about 35
Place of Death: Voting Precinct #4 Hazard, Perry Co., KY
Birth Date: (blank)
Occupation: (blank)
Place of Birth: (blank)
Name of Father: (blank)
Birthplace Father: (blank)
Maiden Name of Mother: (blank)
Birthplace Mother: (blank)
Informant: (blank)
Death Date: 11 October 1912
Cause of Death: Shot & instantly killed by a negro
Signed: Taylor Hurst, M.D.
Burial Place: On Right of way
Date of Burial: 12 October 1912
Undertaker: (blank)
File Date: 14 October 1912
Transcribed by Debbie Tamborski, 03 December 2008 |
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