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DEATH
CERTIFICATE
RACHEL BEVERLY
Date: 09 January 1947
Cert: 05506
Place of Death: County: Floyd City or Town:
Allen
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Allen
Full Name: Rachel BEVERLY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: Harm BEVERLY
Age of husband or wife if alive: (blank)
Birth date of deceased: 01 May
Age: 95 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: SLONE
Father Birthplace: (blank)
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: Cletis BEVERLY, Wayland, Ky.
Burial Place: Dema, Ky.
Date: 11 January 1947
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 19 March 1947
Registrar's Signature: Lucy Ransdell
Date of Death: 09 January 1947
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 12 noon
Immediate cause of death: Senility
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: Marvin Ransdell, M.D.,
Prestonsburg, Ky.
Date signed: 19 March 1947
Transcribed by Debbie Tamborski, 22 June 2010 |
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