Jack Rice (21939)

Item

Official death certificate for Jack Rice. Identifier number 21939.

Title

Jack Rice (21939)

Description

Death certificate for Jack Rice. Born 08-20-1879. Died 08-22-1922.

Identifier

21939

County of Death

Ware

City of Death

Waycross

Address of Death

3 Jacks Lane

Militia District No.

1231

First Name

Jack

Middle Name or Initial

N/A

Last Name

Rice

Address

3 Jacks Lane

Gender

Male

Color or Race

Colored

Marital Status

Single

Date of Birth

August 20, 1879

Age

43 years

Occupation

Shoemaker

Birthplace

Ga [Georgia]

Name of Father

Bob Rice

Birthplace of Father

Ga [Georgia]

Maiden Name of Mother

Margaret Skinner

Birthplace of Mother

Ga [Georgia]

Informant

W. M. Anderson

Informant Address

16 Pittman St

Date Filed

August 23, 1922

Registrar

J. R. Scully

Date of Death

August 22, 1922 15:00

Interval Attended

August 21, 1922 – August 22, 1922

Last Seen Alive

August 22, 1922

Cause of Death

Nephritis

Duration of Care

2 years

Contributory

Uremia

Duration of Contributory

3 months

Operation Preceding Death

No

Autopsy

No

Medical Doctor

T. W. Wells, M.D.

Date of Doctor’s Signature

August 23, 1922

Medical Doctor Address

Waycross, Ga

Place of Burial

Red Hill Cemetery

Date of Burial

August 23, 1922

Undertaker

Arthur E. Jones

Address of Undertaker

Waycross

International List of Causes of Death

Additional Information

Informant did not sign the certificate and left a mark instead. The registrar wrote the name of the informant.