Date:    15 October 1947
Cert:    28986 
Place of Death: County: Knott   City or Town:  Pippapass, Ky.  Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky  County: Knott
City or Town:  Pippapass     Rural 
Full Name:  Hillard JACOBS 
If Veteran Name War: (blank)
Social Security No.:  (blank)
Sex, Color or Race, Marital Status:   Male, White, Married
Husband or Wife of:  Eliza MOORE
Age of husband or wife if alive: 15 years
Birth date of deceased:  29 May 1922 
Age:  25 years, 04 months, 16 days
Birthplace:  Pippapass, Ky. 
Occupation:  Laborer 
Industry or business:  Construction work
Father Name:  Ben JACOBS 
Father Birthplace:  Mousie, Ky. 
Mother Maiden Name:   Dora SLONE 
Mother Birthplace:   Raven, Ky. 
Informant:  Ben JACOBS, Pippapass, Ky. 
Burial Place:   Pippapass, Ky. 
Date:  17 October 1947 
Signature of funeral director:  Floyd Caudill (not an undertaker), Hollybush, Ky.
Date received by local registrar:   24 February 1948
Registrar's Signature: Rose B. Craft
Date of Death:  15 October 1947 
I hereby certify that I attended deceased from (blank) to (blank), that I last saw him alive on (blank), and that death occurred on the date stated above at 6 p.m.
Immediate cause of death:  Gunshot in heart 
Duration: (blank)
Due to:  Despondent - Had broken his back while at work a year ago.
Major findings of operations: (blank)
Accident, suicide, or homicide: Suicide
Date of occurrence: 15 October 1947
Where did injury occur: In the home
While at work:  No
Means of injury: Gun
Signature & Address:  J. W. Duke, M.D., Hindman, Ky.
Date signed:  25 February 1948 
Transcribed by Debbie Tamborski, 18 December 2010