Certificate of Death |
|
Jefferson, Jackson, Ohio |
|
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: |
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|
|
| Industry: |
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|
|
| 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:
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