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DEATH
CERTIFICATE
ALTA FUGATE
Date 18 February 1943
Cert: 12240
Place of Death: County: Perry City or
Town: Rural
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: Rural Street No.:
Fisty, Ky.
Full Name: Alta FUGATE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, (illegible)
Husband or Wife of: Lee FUGATE
Age of husband or wife if alive: 23 years
Birth date of deceased: (blank)
Age: 18 years
Birthplace: Knott Co., Ky.
Occupation: House wf
Industry or business: (blank)
Father Name: Joseph OWENS
Father Birthplace: Knott Co.
Mother Maiden Name: Dellia NAPIER
Mother Birthplace: Perry Co.
Informant: Frank FUGATE, Fisty
Burial Place: Fisty
Date: 19 February 1943
Signature funeral director: Engle Und. & Hdw. Co., Hazard, Ky.
Date received by local registrar: 01 April 1943
Registrar's Signature: Anna L. (illegible)
Date of Death: 18 February 1943
I hereby certify that I attended deceased from (illegible) 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: Eclampsia with (illegible)
puerperal
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: S. M. Richie, M.D., Hazard, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 05 February 2010 |
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