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DEATH
CERTIFICATE
BETTY SUE CAMPBELL
Date 28 September 1940
Cert: 24246
Place of Death: County: Knott City or Town:
Mousie, Ky.
Street Number or Location: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural
Full Name: Betty Sue CAMPBELL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 10 August 1935
Age: 05 years, 01 months, 18 days
Birthplace: Mousie, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: T. C. CAMPBELL
Father Birthplace: Knott Co.
Mother Maiden Name: Grayce MAGGARD
Mother Birthplace: Leburn, Ky.
Informant/Address: T. C. CAMPBELL, Mousie, Ky.
Burial Place: Mousie
Date: 29 September 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 15 November 1940
Registrar's Signature: Macie Miller
Date of Death: 28 September 1940
I hereby certify that I attended deceased from 28 September
1940 to
28 September 1940, that I last saw him alive on 28 September
1940, and that death occurred on the date stated above at 3:05
p.m.
Immediate cause of death: Hit by car killed instantly
Duration: (blank)
Due to: Crushed skull and internal injuries
Major findings of operations: (blank)
Accident, suicide, or homicide: accident
Date of occurrence: 28 September 1940
Where did injury occur: public highway
While at work: no
Means of injury: Crushed Skull
Signature & Address: G. D. Ryan, F. D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 16 August 2010 |
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