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DEATH
CERTIFICATE
EARNEST COLLINS
Date 09 September 1940
Cert: 21963
Place of Death: County: Knott Co. City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Wayland, Ky.
Full Name: Earnest COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Larene NEWSOME
Age of husband or wife if alive: 17 years
Birth date of deceased: 25 December 1920
Age: 19 years, 08 months, 14 days
Birthplace: Wayland, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: F. C. COLLINS
Father Birthplace: Wayland
Mother Maiden Name: Ida MOORE
Mother Birthplace: McDowell, Ky.
Informant/Address: F. C. COLLINS, Wayland, Ky.
Burial Place: Wayland
Date: 11 September 1940
Signature of funeral director/Address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 30 September 1940
Registrar's Signature: Macie Miller
Date of Death: 09 September 1940
I hereby certify that I attended deceased from 26 August 1940 to
09 September 1940, that I last saw him alive on 09 September
1940, and that death
occurred on the date stated above at 4 p.m.
Immediate cause of death: Perdoctomy followed by
appendectomy pneumonia labor
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: W. L. Stumbo, M.D., Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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