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DEATH
CERTIFICATE
CORENA CAZEE
Date 20 October 1940
Cert: 24239
Place of Death: County: Knott City or Town:
Rural
Name of Hospital or Institution: (blank)
Street No. or Address: at home
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Rural If rural
give precinct: Carrie
Full Name: Corena CAZEE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 30 March 1937
Age: 03 years, 06 months, 20 days
Birthplace: Carrie, Ky., Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Charlie CAZEE
Father Birthplace: Breathitt Co., Ky.
Mother Maiden Name: Rosa SMITH
Mother Birthplace: Carrie, Ky., Knott Co.
Informant/Address: Linda ROARK
Burial Place: Carrie, Ky.
Date: 21 October 1940
Signature of funeral director/Address: (blank)
Date received by local registrar: 29 October 1940
Registrar's Signature: Macie Miller
Date of Death: 20 October 1940
I hereby certify that I attended deceased from 18 October 1940 to
20 October 1940, that I last saw her alive on 18 October 1940,
and that death occurred on the date stated above at 2 a.m.
Immediate cause of death: Broncho pneumonia
Duration: (illegible) days
Due to: Whooping cough
Duration: 06 weeks
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Mark Dempsey, Hindman, Ky.
Date signed: 28 October 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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