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DEATH
CERTIFICATE
BERNIECE COLLINS
Date 14 January 1938
Cert: Original #01983 Duplicate
#01888
Place of Death: Voting Pct.: Neon, Letcher Co., Ky.
Full Name: Berniece COLLINS
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White
Husband or Wife of: (blank)
Date of Birth: 14 August 1937
Age: 06 months
Occupation: (blank)
Birthplace: Knott Co.
Father Name: Hillard COLLINS
Birthplace Father: Knott Co.
Mother Maiden Name: Oma COLLINS
Birthplace Mother: Knott Co.
Informant/Address: Mrs. Lula BREEDING, Neon, Ky.
Burial Cremation Removal Place: Knott Co.
Date: 14 January 1938
Undertaker/Address: Johnson Funeral Home, Whitesburg,
Ky.
Filed: 02 February 1938
Registrar: Nerva B. Howard
Death of Date: 14 January 1938
I hereby certify, That I attended deceased from 07 January
1938 to
12 January 1938, that I last saw her alive on 12 January 1938, death is said
to have occurred on the date stated above, at 10 p.m.
Cause of Death: Lobar pneumonia
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: none
What test confirmed diagnosis: physical findings
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: Can M. Bentley, M.D., Neon, Ky.
Transcribed by Debbie Tamborski, 23 April 2010 |
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