I HEREBY CERTIFY, That I attended deceased from Dec 12, 1928, to Dec 24, 1928 that I last saw him alive on Dec 24, 1928 and that death occurred, on the date stated above, at 7 p.m. The CAUSE OF DEATH was as follows; influenza Contributory acute myocarditis.
C. C. Johnson, M.D. Harpers Ferry, W.Va
Place of Burial or Removal
Date of Burial
Dec 28, 1928
J. L. Eackles, Bolivar W.Va
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