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DEATH
CERTIFICATE
CALLIE BURKE
Date 14 June 1940
Cert: 24243
Place of Death: County: Knott City or Town:
Lackey
Name of Hospital or Institution: Stumbo Mem. Hospt.
Length of stay in hospital or community: 03 (illegible)
Usual Residence of Deceased: State: Kentucky County:
Perry
City or Town: Vicco
Full Name: Callie BURKE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Charles BURKE
Age of husband or wife if alive: 51 years
Birth date of deceased: 16 October 1886
Age: 54 years, 06 months, 14 days
Birthplace: Lost Creek, Breathitt Co., Ky.
Occupation: Housewife
Industry or business: (blank)
Father Name: Jerry NOBLE
Father Birthplace: Lost Creek, Breathitt Co., Ky.
Mother Maiden Name: Lindy NEICE
Mother Birthplace: Lost Creek, Breathitt Co., Ky.
Informant/Address: Chas. BURKE, Vicco, Ky.
Burial Place: (illegible)
Date: (blank)
Signature of funeral director/Address: (blank), Hazard
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 14 June 1940
I hereby certify that I attended deceased from 12 June 1940 to
14 June 1940, that I last saw h-- alive on 14 June 1940, and that death
occurred on the date stated above at (blank)
Immediate cause of death: Pneumonia
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: W. L. Stumbo, M.D., Lackey
Date signed: (illegible) 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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