Certificate of Death, File No. 9395. 1. Place of death, County of Jefferson, Township of Winslow 2. Full Name, Susanna Holben Doney 3. Sex, Female 4. Color, white 5. Single, married, widowed, divorced - married 6. Date of Birth, September 26, 1850 7. Age, 70 years, 3 months, 29 days 8. Occupation, Housewife 9. Birthplace, Armstrong County, Pa. 10. Name of father, Samuel Holben 11. Birthplace of father, Northumberland 12. Maiden name of mother, Christine Gruver 13. Birthplace of mother, Clarion Co., Pa. 14. Informant and address, Daniel Doney, Reynoldsville, Route 1. 15. Date, Jan. 28, 1921, Local Registrar, Perry B. Lon ? 16. Date of Death, January 25, 1921 17. I hereby certify that I attended the deceased from Jan. 9, 1921 to Jan.25, 1921 and that I last saw her alive on Jan. 25, 1921 and that death occurred at 10 ? p.m. The cause of death was as follows: Uremic Poisoning, duration 17 days. Contributory, Bright's Disease, signed J.C. Dayi ? M.D., Jan. 28, 1921, Reynoldsville 18. Length of residence: blank 19. Place of Burial, Moore Cemetery; Date of Burial,Jan. 29, 1921 20. Undertaker, ? W kis?, Reynoldsville, Pa.
This needs to be made into a regular source citation -- CJD