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DEATH
CERTIFICATE
(blank)
Date 05 July 1934
Cert: 25261
Name: (blank)
Place of Death: Voting Pct. Upper Caney, Knott Co., KY
Residence: (blank)
Length of residence: (blank)
Female, White, Single
Husband or Wife of: (blank)
Birth Date: 25 February 1934
Age: 04 months, 10 days
Occupation: Nothing
Place of Birth: Pippapass, Knott County
Name of Father: John JACOBS
Birthplace Father: Pippapass, Knott County
Maiden Name of Mother: Cordelia SLONE
Birthplace Mother: Hollybush, Knott County
Informant: (blank)
Death Date: 05 July 1934
Cause of Death: (blank)
Signed: (blank)
Burial Place: J. P. Slone Cemetery
Date of Burial: 06 July 1934
Undertaker: (blank)
File Date: (blank)
Transcribed by Debbie Tamborski, 22 July 2009
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