Date:  21 May 1956
Cert: #56-10394
Place of Death: County: Knott      City or Town: Red Fox
Length of stay (in this place): (blank)
Name of Hospital or Institution:  None
Usual Residence of Deceased: State: Ky.      County:  Knott
City or Town: Red Fox     Street Address: (blank)
Full Name:  Clemm Tina BACK
Date of Death:  21 May 1956
Sex, Color or Race, Marital Status:  Female, White, Widowed
Date of Birth:  18 June 1875
Age: 80 years, 11 months, 03 days
Usual Occupation:  Housewife
Kind of Industry or business: (blank)
Birthplace:  Red Fox, Ky.
Father's Name:  William P. CODY
Mother's Maiden Name:  Matilda BREEDING
Was deceased ever in armed forces:  No
Social Security No.:   None
Informant:  Mrs. Bill BACK - daughter-in-law
Disease or condition directly leading to death: Arteriosclerotic Heart Disease
Interval between onset and death: 20 years
Due to (b): Arteriosclerosis, general
Interval between onset and death: 20 years
Other significant conditions: (blank)
Date of Operation: (blank)
Major findings of operation: (blank)
Autopsy: No
Accident, suicide, or homicide: (blank)
Place of injury: (blank)
City or Town, County, State: (blank)
Time of Injury: (blank)
Injury occurred at work: (blank)
How did injury occur: (blank)
I hereby certify that I attended deceased from 28 June 1949 to 28 April 1956, that I last saw the deceased alive on 28 April 1956, and that death occurred at 7:30 a.m., from the causes and on the date stated above.
Date signed:   24 May 1956
Address:  Hindman, Ky.
Signature:  D. G. Barker, M.D.
Burial, Cremation or Removal: Burial
Date:   23 May 1956
Name of Cemetery or Crematory:  Hilton
Location:   Cody, Ky.
Date received by local registrar:  25 May 1956
Registrar's Signature: Myrtle Slone
Funeral director & address:  Archie Craft, Whitesburg, Ky.
Transcribed by Debbie Tamborski, 26 March 2012