STATE OF NEW YORK CERTIFICATE AND RECORD OF DEATH
(Kings Co.) No. of Certificate 21447
Name of Deceased, Jemima Kidney
Sex -- Female
Color -- White
Age -- 75 yrs
Marital Status -- Widow
Occupation -- House wife
Birthplace -- U.S.
How Long a Resident of City of New York -- "Since Birth"
Place of Death -- 24 Conselyea
Character of Premises -- Tenement
Father's Name -- Anthony A. Maxwell
Father's Birthplace -- NY
Mother's Maiden Name -- "Don't Know"
Mother's Birthplace -- NY
I hereby certify that I attended the deceased from Oct. 1, 1909 to Nov. 19, 1909, that I last saw her alive on the 19th dat of Nov., 1909, that she died on the 19th day of Nov., 1909, about 8 o'clock P.M., and that to the best of my knowledge and belief, the cause of her death was as follows...Apoplexy due to Cerebral Hemorrhage
Witnessed my hand this 20th day of Nov. 1909
John H. Potter M.D.
(Residence) 252 Havenieyerm(?) St.
Place of Burial -- Evergreen Cem.
Date of Burial -- Nov. 22/09
Undertaker -- Wm P(?) Murphy
Place of Business -- 716 Corimer St.

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Also written across the back of Jemima's certificate was "Charles Deisel son law".
I believe that this indicates that a copy of this certificate was delivered to Charles Deisel who was Jemima's son-in-law.

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