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DEATH
CERTIFICATE
(BLANK)
Date 25 June 1911
Cert: # 15647
Name: (blank)
Sex: no information, White
Age: (blank)
Place of Death: Vot Prec Quicksand, Handshoe, Knott Co., KY
Birth Date: 25 June 1911
Occupation: (blank)
Place of Birth: (blank)
Name of Father: (blank)
Birthplace Father: (blank)
Maiden Name of Mother: (blank)
Birthplace Mother: (blank)
Informant: William BALEY, Handshoe
Death Date: 25 June 1911
Cause of Death: don't know
Signed: M. F. Kelley, M.D.
Burial Place: No D(illegible)
Date of Burial: (blank)
Undertaker: (blank)
File Date: 01 July 1911
Transcribed by Debbie Tamborski, 25 November 2008 |
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