Date: 01 December 1943
Cert: 14391
Place of Death: County: Knott City or
Town: Yellow Mountain, Ky.
Street No. or Location: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Yellow Mountain, Ky.
Rural
Full Name: Rachel COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Baby
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 November 1943
Age: 22 days
Birthplace: Knott Co, Ky.
Occupation: None
Industry or business: None
Father Name: Rudolph COLLINS
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Fanny HICKS
Mother Birthplace: Knott Co., Ky.
Informant: Alafair COX, Yellow Mountain, Ky.
Burial Place: Yellow Moutain at Sawyers Cem.
Date: 02 December 1943
Signature of funeral director: Dillard Ritchie, Ivis, Ky.
Date received by local registrar: 23 June 1944
Registrar's Signature: Ida Livingston
Date of Death: 01 December 1943
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: No physician present. The
family reports that the child took suddenly ill and died
before a physician could be had
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. W. Duke, M.D., Hindman, Ky.
Date signed: 16 June 1944
Transcribed by Debbie Tamborski, 20 October 2010 |