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DEATH
CERTIFICATE
Mrs. CORDELIA ROBERTS
Date 31 January 1934
Cert: 00259
Place of Death: Voting Pct.: Jackson, Breathitt Co., Ky.
Full Name: Mrs. Cordelia ROBERTS
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: John ROBERTS
Date of Birth: (blank)
Age: 57 years
Occupation: Housewife
Birthplace: Knott Co., Ky.
Father Name: Robt. DAVIDSON
Birthplace Father: Perry Co., Ky.
Mother Maiden Name: Sarah JOHNSON
Birthplace Mother: Knott Co., Ky.
Informant/Address: Arlie COMBS, Cody, Ky.
Burial Cremation Removal Place: Jeff, Ky.
Date: 01 February 1934
Undertaker/Address: None
Filed: 01 February 1934
Registrar: Mrs. A. W. Brown
Death of Date: 31 January 1934
I hereby certify, That I attended deceased from 01 September
1933 to 31 January 1934, that I last saw her alive on 30
January 1934, death is said
to have occurred on the date stated above, at 12:30 a.m.
Cause of Death: Heart Disease
Date of onset: 01 September 1933
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: no
Signed/Address: Royel Caudill, M.D., Jackson, Ky.
Transcribed by Debbie Tamborski, 16 April 2010 |
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