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DEATH
CERTIFICATE
RACHEL BREEDING
Date 13 October 1940
Cert: 02305
Place of Death: County: Knott City or Town:
Cody
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: Cody
Full Name: Rachel BREEDING
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: George BREEDING
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 January 1866
Age: 64 years
Birthplace: Knott County
Occupation: House work
Industry or business: (blank)
Father Name: Frances AMBURGEY
Father Birthplace: Knott
Mother Maiden Name: Polly MADDEN
Mother Birthplace: Knott Co.
Informant/Address: (blank)
Burial Place: Breedings Creek
Date: 14 October 1940
Signature of funeral director/Address: Family, Cody
Date received by local registrar: 23 January 1941
Registrar's Signature: Macie Miller
Date of Death: 13 October 1940
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: Paralysis
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: G. B. Isom, M.D., Blackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 16 August 2010 |
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