I HEREBY CERTIFY, That I attended deceased from May 15, 1931, to June 27, 1931. I last saw him alive on June 27, 1931, death is said to have occurred on the date stated above at 6 p.m. The principal cause of death and related causes of importance in order of onset were as follows: pulmonary tuberculosis.
C. C. Johnson, M.D. Harpers Ferry, W.Va
Place of Burial or Removal
Date of Burial
July 15, 1931
J. L. Eackles, Bolivar W.Va
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