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DEATH
CERTIFICATE
RACHEL CLIFTON
Date 05 July 1943
Cert: 21059
Place of Death: County: Pike City or Town:
McVay
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Pike
City or Town: McVay
Full Name: Rachel CLIFTON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: J. S. CLIFTON
Age of husband or wife if alive: (blank)
Birth date of deceased: 02 May 1889
Age: 54 years, 02 months, 03 days
Birthplace: Hindman, Ky.
Occupation: Housewife
Industry or business: (blank)
Father Name: Van BURIAN COMBS
Father Birthplace: Ky.
Mother Maiden Name: Unknown
Mother Birthplace: (blank)
Informant: Okey CLIFTON
Burial Place: Hindman
Date: 08 June 1943
Signature of funeral director: M. O. Ball, Williamson, WV
Date received by local registrar: 06 September 1943
Registrar's Signature: Lucille Pruitt
Date of Death: 05 July 1943
I hereby certify that I attended deceased from 22 April 1943 to
05 July 1943, that I last saw him alive on 03 July 1943, and that death
occurred on the date stated above at (blank)
Immediate cause of death: Hypertension, myocardial
degeneration
Duration: (blank)
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: F. J. Burian, McVeigh, Ky.
Date signed: 28 August 1943
Transcribed by Debbie Tamborski, 30 May 2010 |
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