Vital Rec: Laurissa Jane Chambless Moffett death cert., 1962, Winn Parish, LA
Submitted by: Leah Wright Talbot, 591 Brookside Drive, Longmont CO  80501
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State of Louisiana Certificate of Death
State File No. 21 128

Last name of deceased           Moffett
First name                      Laurissa
Second name                     Jane    
Date of death                   Dec. 15, 1962, 6:30 am
Sex                             Female
Color or race                   White
Marital status                  Widowed
Name of husband/wife            (left blank)
Age                             (left blank)
Date of birth of deceased       Aug. 24, 1866
Age of deceased                 96 years
Birthplace           Penola County, Texas (should read Panola County)
Citizen of what country         U.S.A.
Usual occupation                Housewife
Kind of industry or business    Home
Was deceased ever in the U.S. Armed Forces?         No
Social Security No.             None
Place of death: 
City, town, or location         Winnfield
Parish                          Winn
Length of stay in this place    8 months
Name of hospital or institution    Autumn Leaves Nursing Home
Is place of death inside city limits?   Yes
Place of residence:
City or town                    Winnfield
Parish                          Winn
State                           Louisiana
Street Address (if rural, give location)     R. #3
Is residence inside city limits?        No
Is residence on a farm?         No
Name of father                  C. C. Chambless
Birthplace of father             unknown
Maiden name of mother          Emanda Chambless (should read Amanda Chambless)
Birthplace of mother             unknown
Signature of informant         Mrs. Dayton Jones
Date of signature              Dec. 15, 1962
Cause of death                 Coronary occlusion
Interval between onset and death      Minutes
Physician attended the dec. for 8 months
Signature of physician          (illegible)
Date of signature                 12/24/62
Burial/cremation/removal        burial
Date                              12/17/62
Name and location of cemetery   Cypress Creek Cemetery, Dodson, La.
Signature and address of
funeral director                Southern Funeral Home-Winnfield, La.
Burial transit permit number    64-143
Parish of issue                   Winn
Date of issue                     12/17/62
Signature of local registrar    Anthony  (illegible)
Louisiana State Board of Health,
Division of Public Health  Statistics,
Dated Jan 7 1963