Granville Lewis

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Certificate of Death

1. Place of death -- County of Clay, Blair Township

2. Full name -- Granville Lewis

3. Sex -- male

4. Color or race -- white

5. Single, married, widowed, or divorced -- married

5 A. if married, widowed or divorced husband of or wife of -- Charlotte Victoria Lewis

6. Date of birth -- Dec. 20, 1847

7. Age -- 79 years, 10 months, 6 days

8. Occupation of deceased -- Farmer

9. Birthplace -- Clay County, Illinois

10. Name of father -- Jeremiah Lewis

11. Birthplace of father -- West Virginia

12. Maiden name of mother -- Hannah Landreth

13. Birthplace of mother -- unknown

14. Informant -- Frank Lewis, Post Office Address -- Mason, Illinois

15. Filed -- Oct. 27, 1927

16. Date of death -- Oct. 26, 1927

17. I hereby certify, then I attended deceased from July 1926 to date 1927 that I last saw him alive on Oct. 22, 1927 and the death occurred on the date stated of the at 5 a.m. the cause of death was as follows -- Duration -- one year six months

Contributory -- Heart Valve Leaking

18. Signed -- R. L.Falley, M.D. -- address, Bible Grove, Illinois -- date Oct. 27, 1927

19. Place of burial -- Cemetery, Old Union -- Location, Blair Township -- County, Clay

20. Undertaker -- B.F. Glordan Address, Louisville