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DEATH
CERTIFICATE
SISSIE COMBS
Date 31 October 1940
Cert: 02299
Place of Death: County: Knott City or Town:
Leburn
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: Softshell
Full Name: Sissie COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: George COMBS
Age of husband or wife if alive: 67 years
Birth date of deceased: 20 April 1890
Age: 50 years
Birthplace: Knott Co.
Occupation: House wife
Industry or business: (blank)
Father Name: George STAMPER
Father Birthplace: Knott
Mother Maiden Name: Lizzie THACKER
Mother Birthplace: Knott Co.
Informant/Address: George COMBS, Vest, Ky.
Burial Place: Leburn
Date: 01 November 1940
Signature of funeral director/Address: Family
Date received by local registrar: 08 January 1941
Registrar's Signature: Macie Miller
Date of Death: 31 October 1940
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: Pneumonia Lobar
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: J. W. Duke, M.D., Hindman
Date signed: 08 January 1941
Transcribed by Debbie Tamborski, 17 August 2010 |
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