Date:  04 November 1951
Cert:  23000 
Place of Death: County: Knott    City or Town: Hollybush, Ky. Rural
Length of stay (in this place): (blank)
Street address or location:  On Hollybush Creek
Usual Residence of Deceased: State: Kentucky  County: Knott
City or Town:  Hollybush  Rural    If rural give precinct: On Hollybush Creek
Full Name:   Josephine Jacobs
Date of Death:  04 November 1951
Sex, Color/Race, Marital Status: Female, White, Never Married
Date of Birth:  04 July 1951
Age:  04 months
Usual Occupation:  None
Kind of Industry or business: None - Infant
Birthplace:  Hollybush, Knott Co., Ky.
Father's Name:  I. B. JACOBS
Mother's Maiden Name:  Della CAUDILL
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  I. B. JACOBS
Disease or condition directly leading to death: Whooping Cough
Interval between onset and death: 12 days
Due to:  (blank)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy:  No
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from (blank) to (blank), that I last saw the deceased alive on (blank), and that death occurred at (blank), from the causes and on the date stated above.
Date signed:  19 November 1951
Address:  Hindman, Ky.
Signature:  J. W. Duke, M.D.
Burial, Cremation or Removal:  Burial
Date:  05 November 1951
Name of Cemetery or Crematory:  Triplett Graveyard
Location:  Hollybush, Knott, Ky.
Date received by local registrar:  19 November 1951
Registrar's Signature:  Rose B. Craft
Funeral director/address:  Friends & Neighbors, Hollybush, Ky.  Note at page bottom:  Birth of this child reported 15 August 1951 No. 352
Transcribed by Debbie Tamborski, 21 January 2011