Death Certificate of Martha Jane (May) Hodge 1915

Submitted by  Kathy Hines

1915 death cert. - Martha Jane (May) Hodge

  Kentucky Certificate of Death
  Registration District No. 6523
  Primary Registration District No.
  File No. 4694
  Registered No.
  County Laurel Co., KY
  Vot. Pct.:
  City or town: Mershans

  Full Name: Martha Jane Hodge
  Sex: Female
  Color: White
  Marital Status: widow
  Date of Birth of deceased: 11 24, 1837
  Age: 77 yrs, 2 mos., 20 dys.

  Occupation: Housewife
  Birthplace: Laurel, Ky
  Name of Father: Harrison May
  Birthplace of Father: Tenn
  Maiden Name of Mother: Reams
  Birthplace of Mother: Tenn
  Informant's own signature: Calista Hodge
  (Address) Mershons, Ky
  Filed: [blank] [blank] Registrar

  [right hand column of the death certificate]
  Date of Death: 2-14, 1915
  I Hereby Certify That I attended deceased from , 19 to , 19 . I last saw her alive on , 19 death
  is said to have occurred on the date stated above, at __m.
  Cause of Death: [blank]
  Due to:
  Duration:
  (Signed) [blank], M.D.
  (Address) [blank] Date Signed: [blank]
  Burial, cremation, or removal: [blank] Date of burial: 2-15, 1915
  Undertaker: [blank]
  (Address) [blank]