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DEATH
CERTIFICATE
SYNTHA ANN CLEMONS
Date 25 September 1918
Cert: 25035
Place of Death: Voting Precinct: Springfork, Breathitt
Co., Ky.
Full Name: Syntha ann CLEMONS
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: (blank)
Age: 30 years
Occupation: (blank)
Birthplace: Knott Co.
Name of Father: William STACY
Birthplace Father: Perry Co.
Maiden name of Mother: Sallie an RICHIE
Birthplace Mother: Knott Co.
Informant/Address: Kiney CARPENTER, (blank)
Filed: 26 September 1918
Registrar: A. D. Carpenter
Death Date: 25 September 1918
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: Typhoid Fever
Duration: (blank)
Contributory: (blank)
Signed/Address: (blank)
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Lewis Clemons Cem.
Date of Burial: 29 September 1918
Undertaker/Address: Finley Clemons by L.
C. Carpenter, D. R., Guage
Transcribed by Debbie Tamborski, 28 February 2010 |
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