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