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DEATH
CERTIFICATE
ELIZ CAMPBELL
Date: 10 October 1946
Cert: 22628
Place of Death: County: Perry City or Town:
Viper
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: (blank)
Full Name: Eliz CAMPBELL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 22 June
Age: 78 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: John MAGGARD
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: CREECH
Mother Birthplace: Knott Co., Ky.
Informant: William CAMPBELL, Viper, Ky.
Burial Place: Cornett Cem.
Date: 12 October 1946
Signature of funeral director: Joe Green, Hazard, Ky.
Date received by local registrar: 14 October 1946
Registrar's Signature: Opsie J. Deaton
Date of Death: 10 October 1946
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 8:30 p.m.
Immediate cause of death: Cardiac decompensation
Duration: (blank)
Due to: Hypertension
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: C. L. Combs, M.D., Hazard
Date signed: 14 October 1946
Transcribed by Debbie Tamborski, 07 June 2010 |
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