Death Certificate of Rosevelt Bolton 1920

Transcription & photocopy Submitted by Mitzi Freeman March 27, 2002
e-mail address: SETraveler@tngenes.net

Certificate of Death
Certificate: 119969
Place of Death: Laurel
Vot Precinct: Independence
City: Bald Rock
Full Name: Rosevelt Bolton
Sex: Male
Color Race: White
Single, Married, Widowed, or Divorced: Single
Date of Birth: June 12, 1900
Age: 14 yrs 10 mos 8 ds
Occupation: Farm Work
Birth Place: Laurel County, KY
Name of Father: Alex Bolton
Birth Place of Father: Laurel County, KY
Maiden Name of Mother: Mary Tompson
Birth Place of Mother: Knox County, KY
Informant: Robert L. Sears
Address: Bald Rock
Filed: Apr 22, 1920
Registrar: Mrs. C. C. Hale
Date of Death: Apr 20, 1920
I hereby certify that I attended deceased from had no medical attention
that I saw him alive on      and that death occurred, on the date
stated above, at .
The cause of death was as follows: not known, was only sick about 30
minutes was not able to get any physician
Contributory:
Signed: R. L. Sears (no physician)
Address: Bald Rock
Place of Burial or Removal: Poyanter Chape
Date of Burial: Apr 22, 1920
Undertaker: James Bolton
Address: Bald Rock

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