Date:  15 February 1955
Cert:  #03218
Place of Death: County: Knott  City or Town: Pippapass - Rural
Length of stay (in this place): (blank)
Name of Hospital or Institution: (transcriber's note: Stumbo Memorial crossed out)
Usual Residence of Deceased: State: Ky.      County:  Knott
City or Town:  Pippapass - Rural    Street Address: (blank)
Full Name:  Siltane JACOBS
Date of Death:  15 February 1955
Sex, Color or Race, Marital Status:  Female, White, Married
Date of Birth:  17 January 1880
Age: 75 years
Usual Occupation:  Housewife
Kind of Industry or business: (blank)
Birthplace:  Pine Top, Ky.
Father's Name:  Lee THOMAS
Mother's Maiden Name:  Siller SPARKMAN
Was deceased ever in armed forces: (blank)
Social Security No.: (blank)
Informant:  Lee Thomas JACOBS
Disease or condition directly leading to death:  Heart attack
Interval between onset and death:  (blank)
Due to:  75 year old (Senility)
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: (blank)
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: 16 February 1955
Address:  Hindman, Ky.
Signature:  John Everage, Coroner
Burial, Cremation or Removal: Burial
Date:  18 February 1955
Name of Cemetery or Crematory: Jim Slone Cemetery
Location:  Pippapass, Ky.
Date received by local registrar: 22 February 1955
Registrar's Signature: Myrtle Slone
Funeral director & address:  John Everage, Hindman, Ky.
Transcribed by Debbie Tamborski, 13 May 2011