Date: 22 September 1943
Cert: 15304
Place of Death: County: Knott City or
Town: Smithsboro
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: Smithsboro
Full Name: Phoebe COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: about 35 years
Birthplace: (blank)
Occupation: (blank)
Industry or business: (blank)
Father Name: (blank)
Father Birthplace: (blank)
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: (note at bottom of page says Mary Smith
informant)
Burial Place: (blank)
Date: (blank)
Signature of funeral director: (blank)
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 22 September 1943
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: (blank)
Duration: (blank)
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: (blank)
Date signed: (blank)
Transcribed by Debbie Tamborski, 23 October 2010 |