DEATH CERTIFICATE

NANCY JANE SMITH

Date    20 November 1911
Deathvol Vol:   1911
Cert: # 29615
Name: Nancy Jane SMITH
Female, White, Single
Age: 1 year, 3 months, 23 days
Place of Death: Voting Pct. No. 3, Perry Co., KY
Birth Date: 27 August 1910
Place of Birth: Ary, Ky.
Father: Wm. SMITH                                                   Birthplace Father: Ky.
Mother: Mary Elizabeth FIELDS                                 Birthplace Mother: Ky.
Informant: Rachel SMITH
Death Date: 20 November 1911
Cause of Death: Pneumonia
Signed:  S. M. Richie, M.D.
Burial Place: Pigeon Roost
Undertaker: Wm. Smith
File Date: 20 November 1911
Transcribed by Debbie Tamborski, 25 June 2008