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DEATH
CERTIFICATE
GRAYCE CAMPBELL
Date 30 January 1945
Cert: 03086
Place of Death: County: Floyd City or
Town: Martin
Name of Hospital or Institution: Martin General Hosp.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Mousie
Full Name: Grayce CAMPBELL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Turner CAMPBELL
Age of husband or wife if alive: 48
Birth date of deceased: 19 July 1898
Age: 46 years, 06 months, 11 days
Birthplace: Knott Co., Ky.
Occupation: Domestic
Industry or business: (blank)
Father Name: S. D. MAGGARD
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Sally WATTS
Mother Birthplace: Knott Co., Ky.
Informant: Turner CAMPBELL, Mousie, Ky.
Burial Place: Mousie, Ky.
Date: 31 January 1945
Signature of funeral director: G. D. Ryan, Mousie, Ky.
Date received by local registrar: 03 February 1945
Registrar's Signature: (illegible)
Date of Death: 30 January 1945
I hereby certify that I attended deceased from 26 January 1945 to
30 January 1945, that I
last saw him alive on 30 January 1945, and that death occurred on the date
stated above at 12:07 a.m.
Immediate cause of death: Diabetic coma
Due to: Diabetes mellitus
Other conditions: (illegible) liver
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: C. L. Allen, M.D., Martin, Ky.
Date signed: 03 February 1945
Transcribed by Debbie Tamborski, 09 February 2010 |
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