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Jackson County, Ohio
Certificate of Death


 

Certificate of Death
Place of Death:
Jefferson, Jackson, Ohio
File No.
43017
Full Name:
Bertie Low Clark
Registration Dist. No.:
642
Residence:
Primary Reg.: Dist. No.:
4959
Sex:
Female
Registered No.  
Color or Race:
White
Date of Death:
July 5, 1930
S/M/W/D: Single Time of Death: 1:50 am
Spouse:   Served in Military:
Date of Birth: Jan 8 1929 Institution:  
Age: 1y 5m 27d
Cause of death:
Pneumonia
Trade/Profession:      
Industry:      
Date last worked:   Contributory Causes: Whooping Cough
Birthplace City:  
Birthplace Co./St: Ohio
Father: Arthur Clark Born: Ohio  
Mother: Francis Crabtree Born: Ohio  
Informant: Arthur Clark Address: R2 Oak Hill, O
Burial, Cremation or Removal: Burial Date of Burial July 7, 1930
Burial Location Horeb Cemetery
Undertaker: Lew Hughes Address: Jackson, Ohio
Source: State of Ohio Department of Health, Division of Vital Statistics
NOTE:
Contributed by: