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DEATH
CERTIFICATE
HELLIE CLARK
Date 04 May 1926
Cert: 18372
Place of Death: Waynesburg, Lincoln Co., KY
Full Name: Hellie CLARK
Sex, Color or Race, Marital Status: Female, White, Married
Birth date of deceased: Don't know
Age: 18 years
Occupation: H.W.
Birthplace: Ky.
Father Name: Cecil C. BATES
Father Birthplace: Ky.
Mother Maiden Name: Nervie COOK
Mother Birthplace: Ky.
Informant: Cecil C. BATES, Waynesburg, Ky.
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 04 May 1926
I hereby certify that I attended deceased from 03 May 1926 to
04 May 1926, that I last saw him alive on 04 May 1926, and
that death occurred on the date stated above at (illegible)
Cause of death: Puerperal eclamsia
Contributory: Pregnancy & Nephritis
Signature: W. D. (illegible), M.D., Kings Mt., Ky.
Date signed: 04 May 1926
Place of burial of removal: (blank)
Date of burial: (blank)
Undertaker: (blank)
Transcribed by Debbie Tamborski, 05 February 2010 |
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