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DEATH
CERTIFICATE
LYDIA FRANCIS JACOBS
Date: 19 October 1948
Cert: 27032
Place of Death: County: Wolfe
City or Town: Lee City
Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Wolfe
City or Town: Lee City
Full Name: Lydia Francis JACOBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: unknown 1859
Age: 87 years
Birthplace: Knott Co., Ky.
Occupation: Housewife
Industry or business: (blank)
Father Name: Frank CENTER
Father Birthplace: Kentucky
Mother Maiden Name: Martha MCCARTY
Mother Birthplace: Kentucky
Informant: E. L. JACOBS, Helechawa, Ky.
Burial Place: Walters
Date: 21 October 1948
Signature of funeral director: (blank)
Date received by local registrar: 14 December
1948
Registrar's Signature: Irene Spencer
Date of Death: 19 October 1948
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 (blank)
Immediate cause of death: Senility
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: John L. Cox, M.D., Campton
Date signed: 14 December 1948
Transcribed by Debbie Tamborski, 01 July 2010 |
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