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DEATH
CERTIFICATE
HELEN CASEBOLT
Date 12 September 1943
Cert: 19873
Place of Death: County: Floyd City or
Town: Martin
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: Mousie
Full Name: Helen CASEBOLT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: Riley CASEBOLT
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 April 1865
Age: 78 years, 04 months, 28 days
Birthplace: Wayland, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Wm. NICHOLS
Father Birthplace: Wise Co., Va.
Mother Maiden Name: Sarah MARSHALL
Mother Birthplace: Wise Co., Va.
Informant: Lucy SALISBURY, Martin, Ky.
Burial Place: Mousie, Ky.
Date: 14 September 1943
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 29 September 1943
Registrar's Signature: Winifred Norris
Date of Death: 12 September 1943
I hereby certify that I attended deceased from 20 August 1943 to
12 September 1943, that I
last saw him alive on 12 September 1943, and that death occurred on the date
stated above at 10:00 p.m.
Immediate cause of death: Cerebral hemorrhage
Due to: Hypertensive (illegible)
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: J. A. Stumbo, M.D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 05 February 2010 |
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