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DEATH
CERTIFICATE
VIRGIE BEVERLY
Date 08 May 1918
Cert: 12911
Place of Death: Vot. Precinct: Wayland, Martin, Floyd Co., Ky.
Full Name: Virgie BEVERLY
Sex, Color or Race, Marital Status: Female, White,
Single
Date of Birth: 01 April 1903
Age: 15 years, 08 days
Occupation: (blank)
Birthplace: Knott County, Ky.
Name of Father: Maryland BEVERLY
Birthplace Father: Floyd Co., Ky.
Maiden name of Mother: Mary GIPSON
Birthplace Mother: Knott Co., Ky.
Informant/Address: Robert MARTIN, Wayland, Ky.
Filed: (blank)
Registrar: G. S. Howard
Death Date: 08 May 1918
I hereby certify that I attended deceased from 20 January 1918, to
15 March 1918, that I last saw h-- alive on 15 March 1918, and
that death occurred, on the date stated above, at 10 a.m.
Cause of Death: She did dye of tuburculosis (direct cos
of death)
Duration: (blank)
Contributory: (blank) Duration:
06 months
Signed/Address: Dr. N. N. Collins, M.D.,
11 May 1918, Lackey, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Gipson Burrel Sem.
Date of Burial: 09 May 1918
Undertaker/Address: Robert Marshall, Wayland, Ky.
Transcribed by Debbie Tamborski, 28 February 2010 |
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