COMMONWEALTH OF KENTUCKY
Department of Health
Division Of Vital Statistics
CERTIFICATE OF DEATH
File No. 116 69 26113
Registrarās No. 378
Registration District No. 60
Primary Registration District No. 2031
Name of Deceased: Maggie Cox
Date of Death: October 13, 1969
County of Death: Bell City: Pineville
Inside City Limits: Yes
Hospital or other Institution Name:
Pineville Community Hospital
Sex: Female
Color or Race: White
Marital Status: Married Surviving
Spouse: Raleigh Cox
Date of Birth: May 29, 1910
Age: 59 years
State of Birth: KY Citizen
of what country: USA
Residence: State: KY
County: Bell
City, Town or Location: Calvin
Inside City Limits: No
Fatherās Name: Harrison Surgner
Motherās Maiden Name: Birdie Fultz
Informant: Raleigh Cox, Calvin, KY,
40813
Medical Certification:
Cause of Death: (a) Chr
nephritis ö Rheumatoid Arthritis
Due to: (b) secondary anurism
(sic)
Autopsy: Yes If yes, were findings
considered in determining cause of death: Yes
I attended the deceased on 10-13-69;
Death occurred at 8:20 p.m.
The decedent was pronounced dead 10-13-69
at 8:20 p.m.
Certifier name: Charles B. Stacy, M.D.
Pineville, KY 40977
Burial, 10-16-1969 Brafford Cemetery,
Grays, KY
Funeral Director: James S. Durham
Pineville, KY 40977
Name of Embalmer: James S. Durham
Lic. No. 2975
Date recād by local reg. Nov. 7, 1969;
Registrarās Signature: Louise Hightower,
Dep. Reg.
transcribed by Kristi Cox |