Death Certificate of Henry C. Cook
(C. Avis Catalog entry #584)
Texas Department of Health
Bureau of Vital Statistics
Standard Certificate of Death
14072
(Rehmeyer Hospital)
1. Place of Death:
State of Texas
County: Ward
City: Monahans, Texas.
2. Full Name of Deceased: Henry Clarence Cook.
Length of residence where death occurred: 14 years
2. Residence of Deceased: Street and No.: 508 Rodgers City: Monahans County: Ward State: Tex
PERSONAL AND STATISTICAL PARTICULARS
3. Sex: Male, 4. Race: White, 5. Married
6. Date of Birth: 4/1/1893
7. Age: 52 years, 11 months, 23 days
8A. Trade, profession or kind of work done: Merchant
8B. Industry or business in which engaged: Feed
9. Birthplace: Arkansas
10. Father's name: Wm. Henry Cook 11. Birthplace: La.
13. Mother's name: Katherine Shaw 13. Birthplace: La.
14. Informant: Mrs. H. C. Cook [signed] Monahans, Texas
15. Place of burial or removal: Eldorado, Ark. Date: 3-25-1945
16. Undertaker: Walter Burwell, Monahans, Texas
MEDICAL PARTICULARS
17. Date of Death: March 24th, 1945
Death occurred on the date stated above at 1:00 AM
The Primary Cause of Death: Myocarditis
Contributory Causes were Coronary occlusion
Signature: Paul Kenstadt M.D. Cor. Monahans, Texas20. File Number: 25
File Date: 3-25-1945
Signature of local registrar: J. B. Jordan [signed]
Post office address: Monahans, Texas