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DEATH
CERTIFICATE
SALLIE CLEVELAND
Date 29 May 1949
Cert: 17236
Place of Death: County: Perry City or
Town: Hazard, Ky.
Name of Hospital or Institution: Hurst Snyder Hospital
Length of stay in hospital or community: 08 days
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Diablock, Ky.
Full Name: Sallie CLEVELAND
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: C. H. CLEVELAND
Age of husband or wife if alive: 51 years
Birth date of deceased: 25 February 1890
Age: 59 years, 03 months, 04 days
Birthplace: Knott County, Ky.
Occupation: Housewife
Industry or business: Home
Father Name: Marion STAMPER
Father Birthplace: North Carolina
Mother Maiden Name: Martha STEWART
Mother Birthplace: Knott County, KY.
Informant: C. H. CLEVELAND, Box 143, Fort (illegible),
Va.
Burial Place: Dwarf, Ky.
Date: 31 May 1949
Signature of funeral director: Engles, Hazard, Ky.
Date received by local registrar: 07 July 1949
Registrar's Signature: Helen C. Burriss
Date of Death: 29 May 1949
I hereby certify that I attended deceased from 12 December
1948 to 29 May 1949, that I last saw him alive on 29 May 1949,
and that death occurred on the date stated above at 10:30 p.m.
Immediate cause of death: Carcinoma of Uterus
Duration: 05 months
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. C. Coldiron, M.D., Hazard
Date signed: 31 May 1949
Transcribed by Debbie Tamborski, 12 July 2010 |
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