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DEATH
CERTIFICATE
ROXIE COLLINS
Date 29 June 1943
Cert: 13108
Place of Death: County: Floyd City or Town:
Martin
Hospital or Institution: Martin General Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Minnie
Full Name: Roxie COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Madison COLLINS
Age of husband or wife if alive: 30 years
Birth date of deceased: 22 May 1915
Age: 28 years
Birthplace: Knott County
Occupation: Domestic
Industry or business: (blank)
Father Name: Coon MOORE
Father Birthplace: Floyd County
Mother Maiden Name: Polly HOWARD
Mother Birthplace: Knot County
Informant: Madison COLLINS, Minnie, Ky.
Burial Place: Minnie, Ky.
Date: 02 July 1943
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 30 June 1943
Registrar's Signature: Winifred Norris
Date of Death: 29 June 1943
I hereby certify that I attended deceased from 28 June 1943 to
29 June 1943, that I last saw him alive on 29 June 1943, and
that death occurred on the date stated above at 10:00 p.m.
Immediate cause of death: Shock
Duration: (blank)
Due to: Removal of fibroid tumor of uterus
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: C. L. Allen, M.D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 30 May 2010 |
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