|
DEATH
CERTIFICATE
ELBERT JOHNSON
Date 25 April 1913
Cert: 09504
Place of Death: Voting Precinct: Springfork, Breathitt
Co., Ky.
Full Name: Elbert JOHNSON
Sex, Color or Race, Marital Status: Male, White, (blank)
Date of Birth: 1912
Age: 01 years, 01 months, 02 days
Occupation: (blank)
Birthplace: Knott County
Name of Father: Daniel JOHNSON
Birthplace Father: Knott County
Maiden name of Mother: Louiza CLEMONS
Birthplace Mother: Breathitt Co.
Informant/Address: Findy CLEMONS, Guage, Ky.
Filed: 25 April 1913
Registrar: A. D. Carpenter
Death Date: 25 April 1913
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at 3 a.m.
Cause of Death: Diptheria
Duration: 2 days
Contributory: (blank)
Signed/Address: (blank)
Place of Burial or Removal: Clemons Graveyard
Date of Burial: 26 April 1913
Undertaker/Address: Daniel Johnson, Lambric, Ky.
Transcribed by Debbie Tamborski, 24 February 2010 |
|