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DEATH
CERTIFICATE
MARY CAUDILL
Date 07 April 1941
Cert: 12127
Place of Death: County: Floyd City or Town:
Lackey
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott Co.
City or Town: Hollybush
Full Name: Mary CAUDILL
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Harden CAUDILL
Age of husband or wife if alive: 74 years
Birth date of deceased: 03 March 1866
Age: 75 years, 01 months, 04 days
Birthplace: Knott Co., Ky.
Occupation: House Work
Industry or business: (blank)
Father Name: Isom SLONE
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Minerva ACKINS
Mother Birthplace: Knott Co., Ky.
Informant: Floyd CAUDILL, Hollybush, Ky.
Burial Place: Hollybush
Date: 08 April 1941
Signature of funeral director: family, Hollybush
Date received by local registrar: 07 May 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 07 April 1941
I hereby certify that I attended deceased from 03 April 1941 to
03 April 1941, that I
last saw her alive on 03 April 1941, and that death occurred on the date
stated above at (blank)
Immediate cause of death: Pus in left side around lungs
Due to: Traumatism
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: in home
While at work: no
Means of injury: (blank)
Signature: Mark Dempsey, M.D., Hindman, Ky.
Date signed:
Transcribed by Debbie Tamborski, 31 January 2010 |
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