Date:   01 January 1941
Cert:   02300 
Place of Death: County: Knott     City or Town: Sassafras
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Sassafras
Full Name:  Louisa BEVERLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of:   Henry BEVERLY 
Age of husband or wife if alive:  62 years
Birth date of deceased:  1885
Age: 55 years
Birthplace:  Smithsboro, Ky.
Occupation:  House wife
Industry or business: (blank)
Father Name:  Jack COMBS
Father Birthplace:  Smithsboro, Ky.
Mother Maiden Name:  Elizebeth ASHLEY
Mother Birthplace: Smithsboro, Ky. 
Informant:  Henry BEVERLY, Sassafras, Ky.
Burial Place:  Amburgy, Ky.
Date:  03 January 1941
Signature of funeral director: (blank)
Date received by local registrar:  23 January 1941
Registrar's Signature:  Macie Miller
Date of Death:  01 January 1941
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:  Pneumonia Lobar
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. W. Duke, M.D., Hindman
Date signed:  (blank)
Transcribed by Debbie Tamborski, 11 October 2010