DEATH CERTIFICATE

ADRIAN GRIGSBY

Date    05 January 1911
Death Vol:   1911
Cert: # 2297
Name: Adrian GRIGSBY
Male, White, Single
Age: 1 years, 8 months, 19 days
Place of Death: Voting Pct. No. 3, Dwarf, Perry Co., KY
Birth Date: 16 April 1909
Place of Birth: Perry County
Father: Riley GRIGSBY                                                      Birthplace Father: Perry County
Mother: Luney ENGLE                                                       Birthplace Mother: Perry County
Informant: S. M. RICHIE, M.D.
Death Date: 05 January 1911
Cause of Death: Diphtheria
Signed:  S. M. Richie, M.D.
Burial Place: Henry Engle Cemetery
Undertaker: S. B. Richie
File Date: 06 January 1911
Transcribed by Debbie Tamborski, 24 June 2008