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DEATH
CERTIFICATE
PLEAS JACOBS
Date 23 February 1936
Cert: 04955
Place of Death: Voting Pct.: Anchorage,
Lakeland, Jefferson Co., Ky.
Full Name: Pleas JACOBS (Committed from Franklin County,
Kentucky.)
Residence: Central State Hospital, Lakeland, Ky.
Length of Residence: 01 years, 05 months, 04 days
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Rebecca JACOBS
Date of Birth: 14 December 1886
Age: 49 years, 02 months, 09 days
Occupation: Farmer
Birthplace: Knott County, Kentucky
Father Name: Henry C. JACOBS
Birthplace Father: Floyd County, Kentucky
Mother Maiden Name: Martha SLONE
Birthplace Mother: Floyd County, Kentucky
Informant/Address: Central State Hospital, Lakeland, Ky.
Burial Cremation Removal Place: Prestonsburg
Date: 25 February 1936
Undertaker/Address: John Lovely, Wayland, Ky.
Filed: 23 February 1936
Registrar: (illegible) Hawkins 26
February 1936 (illegible) Ferguson
Death of Date: 23 February 1936
I hereby certify, That I attended deceased from 19 September
1936 to
23 February 1936, that I last saw him alive on 23 February
1936, death is said to have occurred on the date stated above,
at 6:40 a.m.
Cause of Death: Pernicious anemia
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: James B. Markey, M.D., Lakeland, Ky.
Transcribed by Debbie Tamborski, 20 April 2010 |
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