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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 |
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