Date: 24 July 1941
Cert: 29465
Place of Death: County: Knott City or
Town: Garner rural
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: Hollybush
Full Name: Ansell CAUDILL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White
Husband or Wife of:
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 18 days
Birthplace: Garner
Occupation: (blank)
Industry or business: (blank)
Father Name: Bruce CAUDILL
Father Birthplace: Hollybush
Mother Maiden Name: Cressa HUFF
Mother Birthplace: Pippapass
Informant: Cressa CAUDILL, Hollybush, Ky.
Burial Place: Hollybush
Date: 25 July 1941
Signature of funeral director: (blank)
Date received by local registrar: 22 December 1941
Registrar's Signature: Ida Livingston
Date of Death: 24 July 1941
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: (blank)
Duration: (blank)
Due to: Measles, no Doctor was called
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: (blank)
Date signed: (blank)
Transcribed by Debbie Tamborski, 11 October 2010 |