Atoka Cemetery Database
Atoka Cemetery, Novice, Coleman County, Texas

Return to Atoka Cemetery Database Homepage.

              Return to Atoka Cemetery Homepage.

Share

COUSINS Jesse B. "J. B."

Male 1891 - 1930  (39 years)


 

«Prev «1 ... 3 4 5 6 7 8 Next»     » Slide Show

Loading...
[editorial comment]

Texas State Board of Health
Bureau of Vital Statistics
Standard Certificate of Death
Form D
Reg. Dis. No,: [cross out]
Registered No: 1703
1. Place of Death:
County of: Tarrant
City:  Ft. Worth
( 2500 Prospect [?] St.; W Ward )
2. Full Name of Deceased: John Pendleton
a. Residence. No [blank] St. 52869
Length of Residence in city or town where death occurred: [blank] Years, 6 Months, [blank] Days
Personal and Statistical Particulars
3. Sex: Male
4. Color or Race: White
5. Single, Married, Widowed or Divorced: Married
6. Date of Birth: 1857
7. Age, Years, Months, Days, If less than 1 Day Hours, Min: 61 years, [blank] months, [blank] days
8A. Occupation, Trade, Profession or Kind of Work Done: [blank]
8B. Industry or Business in Which Engaged: [blank]
9. Birthplace (state or country): Farmer [answer to 8]
10. Father, Name: Pendleton
11. Father, Birthplace (state or country): not known
12. Mother, Maiden Name: not known
13.  Mother, Birthplace (state or country): not known
14. Informant, Signature: J. B. Cousins [son-in-law]
Address: City
15. Filed: 11 - 14 1918, Mrs Jos. King, Registrar
Medical Particulars
16. Date of Death: Nov. 2, 1918
17. I hereby certify that I attended the deceased from Oct. 25, 1910 to Nov. 2, 1918
that I last saw him alive on Nov. 2, 1918
and that death occurred on the date stated Above at 5 AM.
The Cause of Death was as follows: Influenza
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/ [unable to read]
11 - 21 - 1918 (Address) City
19. Place of Burial or Removal: Novice, Texas
Date of Burial: 11 / 31, 1918
20. Undertaker: [unable to read]
Address: City
[no stamp] Department of Health, Texas, Bureau of Vital Statistics
[end]


Death Certificate
PENDLETON John L.
02 November 1918




Owner of originalFamilySearch.org
File namePENDLETONJohnLDeathCertificate.jpg
File Size929.19k
Dimensions1500 x 1158
Linked toCOUSINS Jesse B. "J. B."; PENDLETON John L.

«Prev «1 ... 3 4 5 6 7 8 Next»     » Slide Show





This site powered by The Next Generation of Genealogy Sitebuilding v. 13.1.2, written by Darrin Lythgoe © 2001-2024.

Maintained by Atoka Cemetery Association.


Copyright © 2006 to 2017
Atoka Cemetery Association, 1850 FM 1770, Novice, Texas 79538, Contact us.
This database is powered by The Next Generation of Genealogy Sitebuilding software.