I HEREBY CERTIFY, That I attended deceased from Nov 9, 1933, to Nov 14, 1933. I last saw him alive on Nov 14, 1933, death is said to have occurred on the date stated above at 11:30 p.m. The principal cause of death and related causes of importance in order of onset were as follows: Labor Pneumonia (date of onset about Nov 8, 1933), Contributory causes of importance not related to principal cause: Cerebral Hemorrhage with hemiplegia [?] (date of onset 3 months ago)
C. Johnson, Harpers Ferry, W.Va
Place of Burial or Removal
Date of Burial
Nov 20, 1933
J. L. Eackles, Bolivar W.Va
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