Date:    16 September 1944
Cert:    13008 
Place of Death: County: Knott   City or Town:  Mousie
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County:  Knott
City or Town:  Mousie 
Full Name:  Warren JACOBS 
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status:  Male, White, Child
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:   15 May 1934
Age:  10 years, 04 months, 01 days
Birthplace:  Mousie, Ky. 
Occupation:   (blank)
Industry or business: (blank)
Father Name:  Farris JACOBS 
Father Birthplace:  Ky. 
Mother Maiden Name:  Louranie JACOBS  
Mother Birthplace:  Ky. 
Informant:  Farris JACOBS, Mousie, Ky. 
Burial Place:  Mousie, Ky. 
Date:  17 September 1944 
Signature of funeral director:  Family, Mousie
Date received by local registrar: 04 April 1945 
Registrar's Signature: Rose B. Craft Acting Per B. Carns
Date of Death:  16 September 1944 
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:  Lobar pneumonia 
Duration: (blank)
Due to: The cause of death entered by B. Carns at request of Dr. M. M. Collins
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:  Dr. M. M. Collins, M.D., Lackey, Ky.
Date signed:  04 April 1945 
Transcribed by Debbie Tamborski, 14 November 2010