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DEATH
CERTIFICATE
Mrs. FULTON F. BANKS
Date 12 January 1941
Cert: 02468
Place of Death: County: Letcher City or Town:
Jenkins
Name of Hospital or Institution: Jenkins Hospital
Length of stay in hospital or community: 02 days
Usual Residence of Deceased: State: Kentucky County: Letcher
City or Town: Whitesburg, Ky.
Full Name: Mrs. Fulton F. BANKS
If Veteran Name War: none
Social Security No.: none
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Fulton BANKS
Age of husband or wife if alive: (blank)
Birth date of deceased: 22 January 1904
Age: 36 years, 11 months, 20 days
Birthplace: Knott Co., Ky.
Occupation: Housekeeper
Industry or business: own home
Father Name: John W. COMBS
Father Birthplace: Letcher Co., Ky.
Mother Maiden Name: Matilda MADDEN
Mother Birthplace: Ky.
Informant: Fulton BANKS, Whitesburg, Ky.
Burial Place: Combs Cemetery
Date: 14 January 1941
Signature of funeral director: Ferdinand Moore, Whitesburg,
Ky.
Date received by local registrar: 03 February 1941
Registrar's Signature: E. M. Collins
Date of Death: 12 January 1941
I hereby certify that I attended deceased from 10 January 1941 to
12 January 1941, that I last saw him alive on 12 January 1941,
and that death occurred on the date stated above at 1:30 p.m.
Immediate cause of death: Septicemia
Duration: 03 days
Due to: following influenza
Other conditions: Myocarditis
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: F. D. Willey, M.D., Jenkins,
Ky.
Date signed: 13 January 1941
Transcribed by Debbie Tamborski, 12 May 2010 |
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