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DEATH
CERTIFICATE
LIZA COBURN
Date 01 December 1942
Cert: 27341
Place of Death: County: Lawrence City/Town: Glenwood (rural)
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Lawrence
City or Town: Glenwood, Ky. (rural) Rural Precinct: East Fork
Full Name: Liza COBURN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: Tom COBURN
Age of husband or wife if alive: (blank)
Birth date of deceased: (unknown) 1866
Age: 76 years, 0? months, 0? days
Birthplace: Knott Co., Ky.
Occupation: Housewife
Industry or business: (blank)
Father Name: Joe CHILDERS
Father Birthplace: Ky.
Mother Maiden Name: unknown
Mother Birthplace: unknown
Informant: Ed COBURN, Glenwood, Ky.
Burial Place: Coburn Cem.
Date: 02 December 1942
Signature of funeral director: Family
Date received by local registrar: 02 December 1942
Registrar's Signature: Elizabeth Wallose
Date of Death: 01 December 1942
I hereby certify that I attended deceased from 07 October 1942 to
01 December 1942, that I last saw him alive on 29 October 1942, and that death
occurred on the date stated above at 8:00 p.m.
Immediate cause of death: Heart disease
Duration: (blank)
Due to: Fracture of femur
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: Fall
Signature & Address: E. Carter, M.D., Louisa, Ky.
Date signed: 01 December 1942
Transcribed by Debbie Tamborski, 22 May 2010 |
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