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DEATH
CERTIFICATE
LILLIAN COLLINS
Date 19 August 1945
Cert: 17862
Place of Death: County: Perry City or
Town: Hazard Hosp.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: (blank)
Full Name: Lillian 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: 30 January 1928
Age: 17 years, 06 months, 20 days
Birthplace: Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Robert COLLINS
Father Birthplace: Ky.
Mother Maiden Name: Nancy WARD
Mother Birthplace: Ky.
Informant: Robert COLLINS, Bath, Ky.
Burial Place: Noah Hale
Date: 21 August 1945
Signature of funeral director: Maggard F. H., Hazard, Ky.
Date received by local registrar: 25 August 1945
Registrar's Signature: Opsie J. Deaton
Date of Death: 19 August 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: gunshot wound of left chest
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: Suicide
Date of occurrence: 18 August 1945
Where did injury occur: home
While at work: no
Means of injury: Shot gun
Signature: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 24 August 1945
Transcribed by Debbie Tamborski, 09 February 2010 |
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