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DEATH
CERTIFICATE
RACHEL SPARKMAN CONLEY
Date 12 August 1940
Cert: 21956
Place of Death: County: Knott Co. City or Town:
Mousie
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: Mousie
Full Name: Rachel SPARKMAN CONLEY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Ballard CONLEY
Age of husband or wife if alive: 53 years
Birth date of deceased: 12 March 1898
Age: 42 years
Birthplace: Knott Co.
Occupation: House wife
Industry or business: (blank)
Father Name: Sam SPARKMAN
Father Birthplace: Knott Co.
Mother Maiden Name: Nan MCDOWELL
Mother Birthplace: Knott Co.
Informant/Address: Ballard his X mark CONLEY
Burial Place: Rock Fork
Date: 14 August 1940
Signature of funeral director/Address: Family, Mousie
Date received by local registrar: 14 September 1940
Registrar's Signature: Macie Miller
Date of Death: 12 August 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: Pulmonary Tuberculosis
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, Ky.
Date signed: 14 September 1940
Transcribed by Debbie Tamborski, 17 August 2010 |
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