Date:  16 March 1943
Cert:  09343 
Place of Death: County: Knott     City or Town: Sassafras
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: 06 weeks
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Sassafras     If rural, give precinct:  Sassafras
Full Name:  Emma Mae BEVELRY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status:  Female, White, Single
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  (blank)
Age: 01 months, 08 days
Birthplace:  Sassafras, Ky.
Occupation:  (blank)
Industry or business: (blank)
Father Name:  Edd BEVELRY
Father Birthplace:  Diablock, Ky., Perry Co.
Mother Maiden Name:  Hazel TAYLOR
Mother Birthplace:  Knott Co., Ky.
Informant:  (blank)
Burial Place:  (blank)
Date:  (blank)
Signature of funeral director: (blank)
Date received by local registrar:  22 March 1943
Registrar's Signature:  Ida Livingston
Date of Death:  16 March 1943
I hereby certify that I attended deceased from (blank) to (blank), that I last saw him alive on (blank), and that death occurred on the date stated above at (blank)
Immediate cause of death:  Whooping Cough
Duration: (blank)
Due to: (blank)
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:  J. R. Aker, M.D., Anco, Ky.
Date signed:  17 March 1943
Transcribed by Debbie Tamborski, 19 October 2010