|
DEATH
CERTIFICATE
SMITH COLLINS
Date 08 March 1940
Cert: 17486
Place of Death: County: Knott City or Town:
Amburgey
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Amburgey
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 1779 (transcribed as
written)
Age: 61 years
Birthplace: Letcher Co.
Occupation: Timber worker
Industry or business: (blank)
Father Name: John Wess COLLINS
Father Birthplace: North Ca.
Mother Maiden Name: Nancy ROARK
Mother Birthplace: Magoffin Co.
Informant/Address: J. C. COLLINS, Amburgey, Ky.
Burial Place: Madden Cemetery
Date: 09 March 1940
Signature of funeral director/Address: (blank)
Date received by local registrar: 12 July 1940
Registrar's Signature: Macie Miller
Date of Death: 08 March 1940
I hereby certify that I attended deceased from 1934 to
08 March 1940, that I last saw him alive on (blank), and that
death occurred on the date stated above at 4 a.m.
Immediate cause of death: Coronary Thrombosis Hypertension
Duration: 04 days first detected 1934
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: Guy C. Pinckley, M.D., Anco, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
|