DEATH CERTIFICATE

GROVER CLEAVELAND SMITH

Date  13 March 1927
Cert:  Original # 11373  Duplicate #  06614   
Name:  Grover Cleaveland SMITH 
Place of Death: Voting Pct. #16 Cordia, Knott Co., KY
Male, White, Married
Birth Date:  10 February 1891
Age:  36 years, 01 months, 03 days
Occupation:  Farmer 
Place of Birth:  Knott Co., Ky.
Name of Father:  William SMITH 
Birthplace Father:  Ky. 
Maiden Name of Mother:  Elisebeth JENT
Birthplace Mother:  Ky. 
Informant:  (blank)
Death Date:  13 March 1927 
Cause of Death:  Lobar pneumonia caused by influenza
Signed:  M. F. Kelley, M.D.
Burial Place:  Gayhart Cem.
Date of Burial:  15 March 1927 
Undertaker:  (blank) 
File Date:  (blank) 
Transcribed by Debbie Tamborski, 18 February 2009