Date:   25 August 1943
Cert:   15274 
Place of Death: County: Knott     City or Town: Talcum
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky   County: Knott
City or Town:  Talcum
Full Name:  Henie FUGATE FRANCIS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of:  Sam FRANCIS
Age of husband or wife if alive:  (blank)
Birth date of deceased:  20 April 1862
Age: 81 years, 04 months, 05 days
Birthplace:  Knott County, Ky.
Occupation:  None
Industry or business: (blank)
Father Name:  ---FUGATE
Father Birthplace:  Kentucky 
Mother Maiden Name:  unknown
Mother Birthplace:  Kentucky
Informant:  Pollard RICHIE, Talcum, Kentucky
Burial Place:  Talcum, Kentucky
Date:  26 August 1943
Signature of funeral director:  none
Date received by local registrar:  22 March 1945
Registrar's Signature:  (blank)
Date of Death:  25 August 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:  Myocarditis
Duration: (blank)
Due to: age
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:  22 March 1945
Transcribed by Debbie Tamborski, 23 October 2010