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DEATH
CERTIFICATE
MOSE EVERIDGE
Date 20 October 1933
Cert: 28574
Place of Death: Voting Pct. Maytown #32, Floyd Co., Ky.
Full Name: Mose EVERIDGE
Residence: Langley, Ky.
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Emily JONES EVERIDGE
Date of Birth: (blank)
Age: 64 years
Occupation: (blank)
Birthplace: Knott Co., Ky.
Father Name: Nick EVERIDGE
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: Martha SMITH
Birthplace Mother: Knott Co., Ky.
Informant/Address: Emily JONES, Hindman, Ky.
Filed: 06 December 1933
Registrar: G. S. Howard per B. Carns
Death of Date: 20 October 1933
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), and that death
occurred on the date stated above at (blank)
Cause of Death: Tuberculosis of lungs
Duration: 03 years
Contributory: (blank)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: (blank) Date: (blank)
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: J. M. Allen, M.D., 02
December 1933, Langley, Ky.
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 01 April 2010 |
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