Jack Ross (9709)

Item

Official death certificate for Jack Ross. Identifier number 9709.

Title

Jack Ross (9709)

Description

Death certificate for Jack Ross. Born 12-20-1893. Died 03-10-1923.

Identifier

9709

County of Death

Ware

City of Death

Waycross

Address of Death

860 G St

Militia District No.

1231

Registration District No.

1231

Registered Number

26

First Name

Jack

Middle Name or Initial

N/A

Last Name

Ross

Residence

Waycross

Address

860 G St

Gender

Male

Color or Race

Colored

Marital Status

Married

Spouse

Mrs. Mattie Ross

Date of Birth

December 20, 1893

Age

30 years, 3 months, 20 days

Occupation

Laborer

Birthplace

Houston Co [County]

Name of Father

Jas. [James] Simmons

Birthplace of Father

Virginia

Maiden Name of Mother

Hattie Simmons

Birthplace of Mother

Georgia

Informant

Mrs. Mattie Ross

Informant Address

860 G St, Waycross

Date Filed

March 11, 1923

Registrar

J. R. Scully

Date of Death

March 10, 1923 20:00

Interval Attended

March 5, 1923 – March 10, 1923

Last Seen Alive

March 10, 1923

Cause of Death

Lobar Pneumonia

Contributory

Pericarditis

Medical Doctor

T. W. Wells, M.D.

Date of Doctor’s Signature

March 10, 1923

Medical Doctor Address

Waycross

Place of Burial

Red Hill Cemetery

Date of Burial

April 12, 1923

Undertaker

A. E. Jones [Arthur E. Jones]

Address of Undertaker

Waycross