DEATH CERTIFICATE

BATES JACOBS

Date 13 September 1912
Deathvol
Vol:   1912
Cert: # 22881
Name: Bates JACOBS
Male, White, Single
Age: 2 years, 10 months, 24 days
Place of Death: Voting Pct No. #7, Hollybush, Knott Co., KY
Birth Date: 20 October 1909
Place of Birth: Mallie, Knott Co., KY
Father: John JACOBS                                                Birthplace Father: Knott Co., KY
Mother: Katherine CAUDILL                                               Birthplace Mother: Knott Co., KY
Informant: John JACOBS
Death Date: 13 September 1912
Cause of Death: Not Listed
Signed:   Not Listed
Burial Place: J.P. Slone Cemetery
Undertaker: John Jacobs
File Date: 24 September 1912
Transcribed by Debbie Tamborski, 17 June 2008