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DEATH
CERTIFICATE
Mrs. Andrew BENTLEY (VIRGIE MAE)
Date 12 January 1940
Cert: 10421
Place of Death: County: Knott City or Town:
Anco, Kentucky
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Rural Anco #20
Full Name: Mrs. Andrew BENTLEY (Virgie Mae)
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Andrew BENTLEY
Age of husband or wife if alive: 34 years
Birth date of deceased: 04 April 1913
Age: 26 years
Birthplace: Kentucky
Occupation: Housewife
Industry or business: (blank)
Father Name: Wilburn CAUDILL
Father Birthplace: Kentucky
Mother Maiden Name: Louisa CRASE
Mother Birthplace: Kentucky
Informant/Address: Andrew BENTLEY, Anoc, Kentucky
Burial Place: Carbin Glow, Ky.
Date: 13 January 1940
Signature funeral director/address: William S.
Norris, Hazard, Ky.
Date received by local registrar: 28 February 1940
Registrar's Signature: Macie Miller per B. Carns
Date of Death: 12 January 1940
I hereby certify that I attended deceased from (illegible) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 6 a.m.
Immediate cause of death: (illegible) Shock
Duration: (blank)
Due to: (illegible) contraction (illegible) prolonged labor
(illegible)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Guy C. Pinkley, M.D., Anco, Ky.
Date signed: 21 February 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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