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DEATH
CERTIFICATE
SUSIE A. COMBS
Date 09 August 1941
Cert: 20831
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hosp. Co.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Emmalena
Full Name: Susie A. COMBS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 21 February 1941
Age: 05 months
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Hebert COMBS
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Ursula COMBS
Mother Birthplace: Knott Co., Ky.
Informant: Herbert COMBS, Emmalena
Burial Place: Knott Co.
Date: 10 August 1941
Signature of funeral director: Engle Und.
& Hdw. Co., Hazard, Ky.
Date received by local registrar: 19 August 1941
Registrar's Signature: Kathryn S. Johnson
Date of Death: 09 August 1941
I hereby certify that I attended deceased from 09 August 1941 to
09 August 1941, that I
last saw her alive on 09 August 1941, and that death occurred on the date
stated above at 11:20 a.m.
Immediate cause of death: Bacillary dysentery
Other conditions: Diarrhea and Dehydration
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: J. E. Hagan, M.D., Hazard, Ky.
Date signed: 19 August 1941
Transcribed by Debbie Tamborski, 01 February 2010 |
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