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DEATH
CERTIFICATE
KATHALINE CONLEY
Date 22 December 1940
Cert: 29251
Place of Death: County: Knott Co. City or Town:
Vest, Ky.
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: Vest
Full Name: Kathaline CONLEY
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: 15 February 1940
Age: 10 months, 07 days
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Lee CONLEY
Father Birthplace: Knott Co.
Mother Maiden Name: Julia MESSER
Mother Birthplace: Knott Co.
Informant/Address: Lee CONLEY, Vest, Ky.
Burial Place: Vest
Date: 24 December 1940
Signature of funeral director/address: Family, Vest, Ky.
Date received by local registrar: 31 December 1940
Registrar's Signature: Macie Miller
Date of Death: 22 December 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: Whooping cough
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: Susan Owsley, Vest, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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