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COUSINS Jesse B. "J. B."

Male 1891 - 1930  (39 years)


 

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[editorial comment]

Texas Department of Health
Bureau of Vital Statistics
Standard Certificate of Death
Registrar's No: 76
[stamp] 46587 / 43677
1. Place of Death: State of Texas
County of: Williamson
City or Precinct No: Georgetown [strikethrough]
Give Street and Number: [blank]
2. Full Name of Deceased: J. B. Cousins
Residence of the Deceased, Street and No, City, County, State: [blank]
Length of Residence Where Death Occurred, Years-Months-Days: [blank]
Personal and Statistical Particulars
3. Sex: Male
4. Color or Race: White
5. Single, Married, Widowed or Divorced: Married
5a. Husband / Wife of: Lizzie Cousins
6. Date of Birth: Mar 24, 1891
7. Age, Years, Months, Days, If less than 1 Day Hours, Min: 39 years, 5 months, 16 days
8A. Occupation, Trade, Profession or Kind of Work Done: Farmer
8B. Industry or Business in Which Engaged: [blank]
9. Birthplace (state or country): Texas
10. Father, Name: Don’t no [sic]
11. Father, Birthplace (state or country): [blank]
12. Mother, Maiden Name: [blank]
13.  Mother, Birthplace (state or country): [blank]
14. Informant, Signature: L Pendleton [James Lewis PENDLETON, brother-in-law]
Address: Novice, Texas
15. Filed: Sept 15th 1930, [unable to read] Registrar
Medical Particulars
16. Date of Death: Sept 14, 1930
17. I hereby certify that I attended the deceased from [blank] to [blank] 
that I last saw [blank] alive on [blank]
and that death occurred on the date stated Above at 5:30 PM.
The Cause of Death was as follows: Killed by train
Duration: [blank]
Contributory Causes: [blank]
Duration: [blank]
18. Where was disease contracted? [blank]
If not at place of death?[blank]
Did operation precede death? [blank] Date: [blank]
Was there an autopsy? [blank]
What test confirmed diagnosis? [blank]
(Signed) s/ W. F. Marton, M. D.
Sept 15th, 1930 (Address) Georgetown, Tex
19. Place of Burial or Removal: Novice, Texas
Date of Burial: 9 / 15, 1930
20. Undertaker: W. H. Davis [unable to read] Co
Address: Georgetown, Texas
[no stamp] Department of Health, Texas, Bureau of Vital Statistics
[end]


Death Certificate
COUSINS Jesse B.
14 September 1930




File nameCOUSINSJesseBDeathCertificate.jpg
File Size986.53k
Dimensions1636 x 1424
Linked toCOUSINS Jesse B. "J. B."; PENDLETON James Lewis; PENDLETON COUSINS Margaret Elizia "Lizzie"

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