CA424

Death Certificate of Dr. Jake Avis, Jr.
(C. Avis Catalog entry #424)

STATE OF TEXAS
CERTIFICATE OF DEATH
STATE FILE NO. 42888

Place of Death:  Travis County, Austin, Brakenridge Hospital (within city limits)
Usual Residence:  Travis County, Texas, Austin, 1510 Rainbow Bend (within city limits, not a farm)
Name of deceased:  Jake Avis, Jr.
Date of death:  February 21, 1961
Male, White, Married
Date of Birth:  April 21, 1922
Age: 38
Usual occupation:  Dentistry  Kind of business or industry:  Dentistry
Birthplace:  Wichita Falls, Texas
Citizen of USA
Father's Name:  A. W. (Jake) Avis, Sr.
Mother's Name:  Gladys Roberson
Was deceased ever in U.S. Armed Forces:  Yes, WW II
Social Security No.:
Informant:  Mrs. Jake Avis, Jr. [printed and signed]

CAUSE OF DEATH:
    Immediate cause:  Intrathoracic hemorrhage 
    Due to:  Gunshot wound, left chest
    Interval between onset and death:  1-2 hr
Was autopsy performed:  No
Accident, Suicide, Homicide [none checked]
Time of injury:  2-21-61
Injury occurred:  Not while at work
Place of injury:  home, Austin, Travis County, Texas

I hereby certify that I attended the deceased from Feb. 21 1961 to Feb. 21, 1961 and last saw the deceased alive on Feb. 21, 1961.  Death occurred at 1:15 p.m. on the date stated above to the best of my knowledge, from the causes stated.
Signature:  R. Maruice Head  M.D.
Address:  Medical Arts Square, Austin, Texas
Date signed:  7-27-61

Burial, cremation, removal:  Burial
Date:  Feb. 23, 1961
Name of Cemetery:  Austin Memorial Park, Austin, Travis Cty, Texas
Funeral Director's Signature:  Gordon Pennington, Jr. [printed and signed], Weed-Corley Funeral Home, Ltd.  #2858

Registrar's file no.:  969
Date recorded:  8-1-1961
Registrar's signature:  B. M. Premer, M. D. [signed]  Austin, Texas