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DEATH
CERTIFICATE
SMITH COLLINS
Date 08 March 1940
Cert: 10939
Place of Death: County: Perry City or
Town: Rural
Name of Hospital or Institution: Amburgey
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Perry
City or Town: Rural
Full Name: Smith COLLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Elizabeth COLLINS
Age of husband or wife if alive: 59 years
Birth date of deceased: 19 January 1878
Age: 61 years
Birthplace: Knott Co., Ky.
Occupation: Carpenter
Industry or business: (Wholesale & retail lumber)
Father Name: John COLLINS
Father Birthplace: Letcher Co., Ky.
Mother Maiden Name: ? Nancy ROARK
(transcribed as written)
Mother Birthplace: ? Letcher Co., Ky.
(transcribed as written)
Informant: Harold COLLINS, Amburgey, Ky.
Burial Place: Burial - Amburgey
Date: 10 March 1940
Signature of funeral director: Harold COLLINS, Amburgey
Date received by local registrar: 23 April 1940
Registrar's Signature: Eunice H. Ribble
Date of Death: 08 March 1940
I hereby certify that I attended deceased from 04 March 1940
to Death, that I last saw him alive on 08 March 1940, and that
death occurred on the date stated above at 3:10 a.m.
Immediate cause of death: Coronary Thrombosis
Duration: 04 days
Due to: Hypertensive (illegible)
Duration: 06 years
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: Guy C. Pinckley, M.D., Anco, Ky.
Date signed: 26 March 1940
Transcribed by Debbie Tamborski, 08 May 2010 |
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