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DEATH
CERTIFICATE
ROSINA COLLINS
Date: 04 December 1947
Cert: 28249
Place of Death: County: Floyd City or Town:
Martin
Hospital or Institution: Beaver Valley Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Buckingham
Full Name: Rosina COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: Willard COLLINS
Age of husband or wife if alive: (blank)
Birth date of deceased: 1898
Age: 49 years
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Andy CAUDILL
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Sarah REYNOLDS
Mother Birthplace: Floyd Co., Ky.
Informant: Addison COLLINS, Buckingham, Ky.
Burial Place: Dema, Ky.
Date: 06 December 1947
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 15 January 1948
Registrar's Signature: Lucy Ransdell
Date of Death: 04 December 1947
I hereby certify that I attended deceased from 01 December
1947 to
04 December 1947, that I last saw him alive on (blank), and
that death occurred on the date stated above at 4:10 p.m.
Immediate cause of death: Intestinal obstruction
Duration: (blank)
Due to: Adhesions
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: Robert M. Sirkle, M.D., Martin
Date signed: 10 January 1948
Transcribed by Debbie Tamborski, 22 June 2010 |
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