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DEATH
CERTIFICATE
ROSANNA CASEBOLT
Date 10 June 1940
Cert: 15187
Place of Death: County: Knott City or Town:
Leburn
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: Leburn
Full Name: Rosanna CASEBOLT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Divorced
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 12 May 1866
Age: 74 years
Birthplace: Knott
Occupation: House keeper
Industry or business: (blank)
Father Name: Bill CASEBOLT
Father Birthplace: Knott
Mother Maiden Name: Arminda COMBS
Mother Birthplace: Knott
Informant/Address: Mrs. Lloyd MAGGARD
Burial Place: Mill Creek
Date: 11 June 1940
Signature of funeral director/Address: (blank)
Date received by local registrar: 27 June 1940
Registrar's Signature: Macie Miller
Date of Death: 10 June 1940
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 (blank)
Immediate cause of death: Paralysis
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: J. W. Duke, Hindman
Date signed: 28 June 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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