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DEATH
CERTIFICATE
Mrs. SALLIE COLLINS
Date 08 April 1941
Cert: 10708
Place of Death: County: Letcher City or Town:
Rural
Name of Hospital or Institution: Isom
Length of stay in hospital or community: 02 months
Usual Residence of Deceased: State: Kentucky County: Letcher
City or Town: Rural Street No.:
Isom
Full Name: Mrs. Sallie COLLINS
If Veteran Name War: (blank)
Social Security No.: none
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: John COLLINS
Age of husband or wife if alive: 77 years
Birth date of deceased: 09 April 1863
Age: 77 years, 11 months, 30 days
Birthplace: Knott County, Ky.
Occupation: Housekeeper
Industry or business: (blank)
Father Name: John STACY
Father Birthplace: Ky.
Mother Maiden Name: Mary CORNETT (?) [sic]
Mother Birthplace: Ky.
Informant: Don COLLINS, Whitesburg, Ky.
Burial Place: Colson, Ky.
Date: 09 April 1941
Signature of funeral director: family, Isom, Ky.
Date received by local registrar: 11 April 1941
Registrar's Signature: E. M. Collins
Date of Death: 08 April 1941
I hereby certify that I attended deceased from 28 March 1941 to
31 March 1941, that I last saw her alive on 31 March 1941, and
that death occurred on the date stated above at 11:10 a.m.
Immediate cause of death: Myocarditis (chronic)
Duration: 02 years
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: Carl Pigman, M.D., Whitesburg,
Ky.
Date signed: 08 April 1941
Transcribed by Debbie Tamborski, 12 May 2010 |
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