Death Certificate of Crooks, Mary Jane Mary Jane Crooks, daughter of Samuel Davis and Barbary, was born 24 Jan 1815 in Indiana. She died 05 Sep 1905 in Bond, Union Township, Parke County, Indiana from Cerebral Degeneration at age 90 years, 7 months, 12 days. She was married to Samuel Crooks. She was buried 07 Sep 1905 at Black Creek Cemetery. ------------------------------------------------------------------------------------------------ | ID | Section | Field Description | Value | |----|------------------------------|----------------------------|-----------------------------| | 1 | Place of Death | County | Parke | | 2 | Place of Death | Township | Union | | 3 | Place of Death | Town or City | (Blank) | | 4 | Place of Death | Street/Ward | (Blank) | | 5 | Personal and Statistical | Full Name | Mary Jane Crooks | | 6 | Personal and Statistical | Sex | Female | | 7 | Personal and Statistical | Color | White | | 8 | Personal and Statistical | Marital Status | Married | | 9 | Personal and Statistical | Name of Husband or Wife | Samuel Crooks | | 10 | Personal and Statistical | Date of Birth | January 24, 1815 | | 11 | Personal and Statistical | Age | 90 years, 7 months, 12 days | | 12 | Personal and Statistical | Occupation | Ind | | 13 | Personal and Statistical | Birthplace | Ind | | 14 | Personal and Statistical | Place of Death | Bond | | 15 | Personal and Statistical | Name of Father | Samuel Davis | | 16 | Personal and Statistical | Birthplace of Father | Ohio | | 17 | Personal and Statistical | Maiden Name of Mother | Barbary | | 18 | Personal and Statistical | Birthplace of Mother | (Blank) | | 19 | Personal and Statistical | Informant | Samuel Crooks | | 20 | Medical Certificate of Death | Date of Death | Sept 5, 1905 | | 21 | Medical Certificate of Death | Date Last Seen Alive | Sept 5, 1905 | | 22 | Medical Certificate of Death | Time of Death | 2 o'clock A.M. | | 23 | Medical Certificate of Death | Chief Cause of Death | Cerebral Degeneration | | 24 | Medical Certificate of Death | Duration (Chief Cause) | 4 months | | 25 | Medical Certificate of Death | Immediate Cause | (Blank) | | 26 | Medical Certificate of Death | Duration (Immediate Cause) | (Blank) | | 27 | Medical Certificate of Death | Physician Name | R. O. Pearce, M.D. | | 28 | Medical Certificate of Death | Physician Address | Bellmore, Ind. | | 29 | Medical Certificate of Death | Date Signed | Sept 6, 1905 | | 30 | Burial/Removal | Place of Burial/Removal | Bleak[Blake] Cemetery | | 31 | Burial/Removal | Proposed Date of Burial | Sept 7, 1905 | | 32 | Burial/Removal | Undertaker | J. J. Wood | | 33 | Burial/Removal | Undertaker Address | Rockville, 1905 | | 34 | Burial/Removal | Date Filed | Sept 7, 1905 | | 35 | Burial/Removal | Registrar | C. L. Morris | | 36 | Burial/Removal | Registrar Address | Rockville, Ind. | ------------------------------------------------------------------------------------------------