Date:   1943
Cert:    15302
Place of Death: County: Knott     City or Town: Carrie
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:  Carrie
Full Name:  Sallie CORNETT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widow
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  (blank)
Age: about 90 years
Birthplace:  (blank)
Occupation:  Hswf.
Industry or business: (blank)
Father Name:  (blank)
Father Birthplace:  (blank)
Mother Maiden Name:  (blank)
Mother Birthplace:  (blank)
Informant:  (note at bottom of page--Bruce CORNETT, Carrie, informant)
Burial Place: (blank)
Date:  (blank)
Signature of funeral director: (blank)
Date received by local registrar:  (blank)
Registrar's Signature:  (blank)
Date of Death:  1943
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: (blank)
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: (blank)
Date signed:  (blank)
Transcribed by Debbie Tamborski, 23 October 2010