Samuel Alexander KNOWLES Death Certificate

TEXAS DEPARTMENT OF HEALTH

BUREAU OF VITAL STATISTICS

STANDARD CERTIFICATE OF DEATH

Registrar's No.: 27220

1. Place of Death

STATE OF TEXAS

COUNTY OF: Jones

CITY OR PRECINCT NO.: Avoca

Length of residence in city where death occurred: 32 yrs.

How long in U.S. if foreign born? [blank]

2. FULL NAME OF DECEASED: Samuel Alexander Knowles

RESIDENCE OF DECEASED:

No. [blank]

Street [blank]

City: Avoca

State: Tex

PERSONAL AND STATISTICAL PARTICULARS

3. SEX: Male

4. COLOR OR RACE: White

5. Widowed

5a. If married, widowed, or divorced

HUSBAND of

(or) WIFE of: [blank]

6. DATE OF BIRTH: Dec. 25, 1857

7. AGE: 79 years, 5 months, 3 days

OCCUPATION:

8. Trade...: Retired Merchant

9. Industry...: [blank]

10. Date deceased last worked...: [blank]

11. Total time (years) spent in this occupation: [blank]

12. BIRTHPLACE: Iuka, Miss.

FATHER:

13. NAME: W. H. Knowles

14. BIRTHPLACE: England

MOTHER:

15. MAIDEN NAME: Unknown

16. BIRTHPLACE: [blank]

17 INFORMANT: L. C. Knowles

(Address): Avoca, Tex.

18. BURIAL, REMOVAL

Place: Highland

Date: May 30, 1937

19. UNDERTAKER: J. H. Kinney

(Address): Stamford, Texas

20. SIGNATURE AND FILE DATE OF LOCAL REGISTRAR

(File Date): May 31, 1937

(Signature): Thos. Stifflemier

MEDICAL PARTICULARS

21. DATE OF DEATH: May 28, 1937

22. I HEREBY CERTIFY, That I attended deceased from 4-11, 1937, to 5-27, 1937. I last saw him alive on 5-27, 1937; death is said to have occurred on the date stated above at 8:00 p.m.

The principal cause of death and related causes of importance were as follows:

Myocardial Failure

Date of Onset: [blank]

Other contributory causes of importance:

Senility

Date of Onset: [blank]

[remainder of medical section is blank]

(Signed) S. W. Bailey, M.D.

(Address) Lueders, Texas