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DEATH
CERTIFICATE
SARAH COMBS
Date 11 January 1940
Cert: 01964
Place of Death: Voting Pct. No. 4, Knott Co., Ky.
Full Name: Sarah COMBS
Residence: Elmrock
Length of Residence: (blank)
Sex, Color/Race, Marital Status: Female, White, Widdow
[sic]
Husband or Wife of: (blank)
Date of Birth: 07 January 1857
Age: 83 years, 88 months, 04 days
Occupation: 00
Birthplace: Ky.
Father Name: Adam ALLEN
Birthplace Father: Ky.
Mother Maiden Name: Myme GAYHEART
Birthplace Mother: (blank)
Informant/Address: Sam COMBS, Elmrock
Filed: 11 January 1940
Registrar: Garson Combs
Death of Date: 11 January 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), and that death
occurred on the date stated above at (blank)
Cause of Death: Pneumonia no doctor
Duration: (blank)
Contributory: (blank)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: (blank)
Place of Burial or Removal: Smith Cemetery
Date of Burial: 11 January 1940
Undertaker/Address: W. M. Compton, Elmrock
Transcribed by Debbie Tamborski, 16 August 2010 |
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