Date: 20 January 1945
Cert: 03959
Place of Death: County: Knott City or
Town: Rural Anco
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: 01 day
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Anco
Full Name: Bettie Susan COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 20 January 1945
Age: 01 days
Birthplace: Anco, Ky.
Occupation: None
Industry or business: (blank)
Father Name: Sam COLLINS
Father Birthplace: West Virginia
Mother Maiden Name: Ann ZBACNIK
Mother Birthplace: Anco, Ky.
Informant: Dr. J. R. AKER, Anco, Ky.
Burial Place: (blank)
Date: (blank)
Signature of funeral director: (blank)
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 20 January 1945
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Strangulation from fluid in
lungs
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: J. R. Aker, M.D., Anco, Ky.
Date signed: 24 February 1945
Transcribed by Debbie Tamborski, 26 November 2010 |