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DEATH
CERTIFICATE
SHADE FUGATE
Date 21 January 1935
Cert: 15220
Place of Death: Vot. Pct.: Hell fer Sartin, No. 23, Leslie
Co., Ky.
Full Name: Shade FUGATE
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Rebecca FUGATE
Date of Birth: (blank)
Age: 59 years
Occupation: farmer
Birthplace: Knott County
Father Name: Abe FUGATE
Birthplace Father: Knott
Mother Maiden Name: Leanna HOLIDAY
Birthplace Mother: Perry County
Informant/Address: Godfrey HOLIDAY, Dryhill
Burial Cremation Removal Place: Hell fer Sartin
Date: 22 January 1935
Undertaker/Address: (blank)
Filed: 16 June 1935
Registrar: Zilpha Roberts
Death of Date: 21 January 1935
I hereby certify, That I attended deceased from (blank) to
(blank), that I last saw h-- alive on (blank), death is said
to have occurred on the date stated above, at (blank)
Cause of Death: Heart failure (suddenly)
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: (blank)
Transcribed by Debbie Tamborski, 17 April 2010 |
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