Genealogy Pages for Northern Middle TN
Death Certificate for Mary JIRKOVSKI
| Following is a transcription of the above
person's (TN) death certificate: Place of Death: County: Robertson, Civil Dist.: 6, Reg. Dist.: 47506 Village or City: Adams, File No.: 69 Full Name: Mary JIRKOVSKI Sex: female Race: white Marital Status: Widowed Date of Birth: 1846 Age: 71 yrs. Occupation: House Keeping Birthplace: (blank) Name of Father: (blank) Birthplace of Father: (blank) Maiden Name of Mother: (blank) Birthplace of Mother: Bohemar or Bohemor Informant: C. Bailey BELL Address: Adams, Tenn. Filed: 06/28/1917 E. W. Robertson, Registrar Date of Death: 06/27/1917 The physician last saw her alive on 06/27/1917 Death occurred on date above at 4 pm Cause of Death: Hanging. It would appear that it was done with premeditated intention of suicide. Signed: O Bailey BELL, M. D. Date: 06/28/1917 Address: Adams, Tenn. Place of Burial: Bell Burial Grounds Date of Burial: 06/28/1917 Undertaker: E. W. Robertson & Co. Address: Adams, Tenn. |