Elizabeth Amanda GUY (Bolin) Death Certificate

INDIANA

STATE BOARD OF HEALTH

Certificate and Record of Death

County: Morgan

Township: Baker

Health Officer's Record Number: 5

[stamped number]: 24

Decedent's full Name: Elizabeth A. Bowlin

Date of Death: Month: 1 Day: 29 Year: 1901

MEDICAL CERTIFICATE OF DEATH:

I hereby certify that I attended the deceased from Jan. 1, 1900 to Jan. 28, 1901, that I last saw her alive on Dec. 11th, 1900, that She died on Jan. 28th about 2 o'clock P.M., and that to the best of my knowledge and belief the CAUSE OF DEATH was as hereunder written:

Disease caising death? Consumption

Duration: Twelve month

Immediate cause of death? "

Duration: "

Contributory causes or complications, if any? Heart Trouble

Duration: "

Post-mortem: None

Witness my hand this 29 day of January

Signature of Physician, Coroner. . .: John Kennedy

Address: Paragon Ind.

RECORD OF DEATH:

Age: 76 years

Full Name of Deceased: Elizabeth A. Bowlin

Sex: W

Color: [blank]

Residence: Baker T. P.

Widow

Occupation? House wife

Birthplace? North Carolina

Place of Death? Baker T.P.

Father's name in full? Samuel Guy

Father's Birthplace? Carolina

Mother's maiden name in full? Don't know

Mother's Birthplace? Carolina

Date of Burial? January 29th 1901

Place of Burial? Union

Reported by: E. M. Bolin

Address: Paragon, Ind

Signature of Undertaker: Hyram Hinson

Address of Undertaker: Martinsville