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DEATH
CERTIFICATE
LOLA B. SMITH
Date 30 December 1913
Cert: 32867
Place of Death: Vot. Prec.: Bekhim #8, Jenkins, Litchir
Co., Ky.
Full Name: Lola B. SMITH
Sex, Color or Race, Marital Status: Female, White,
Single
Date of Birth: 20 January 1911
Age: 02 years, 11 months, 21 days
Occupation: (blank)
Birthplace: Knott Co., Ky.
Name of Father: Robt. SMITH
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Nancy COMBS
Birthplace Mother: Perry Co., Ky.
Informant/Address: Robt. SMITH, Jenkins, Ky.
Filed: 30 December 1913
Registrar: John Collins
Death Date: 30 December 1913
I hereby certify that I attended deceased from 24 December
1913, to
30 December 1913, that I last saw her alive on 29 December
1913, and that death occurred, on the date stated above, at 5
a.m.
Cause of Death: Diphtheria
Duration: 06 days
Contributory: (blank)
Signed/Address: W. L. Gambill, 30
December 1913, Jenkins, Ky.
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 24 February 2010 |
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