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DEATH
CERTIFICATE
FANNY GAYHEART
Date 12 January 1917
Cert: 00919
Place of Death: Voting Precinct: Painter Harve, Weeksbury,
Floyd Co., Ky.
Full Name: Fanny GAYHEART
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: 13 June 1912
Age: 04 years, 11 months, 29 days
Occupation: (blank)
Birthplace: Beaver, Ky.
Name of Father: Edward GAYHEART
Birthplace Father: Va.
Maiden name of Mother: Susie VANCE
Birthplace Mother: Beaver, Ky.
Informant/Address: (blank)
Filed: 01 February 1917
Registrar: E. Hiram Hall
Death Date: 12 January 1917
I hereby certify that I attended deceased from 04 January 1917, to
11 January 1917, that I last saw him alive on 11 January 1917,
and that death occurred, on the date stated above, at 2 a.m.
Cause of Death: Measles
Duration: (blank)
Contributory: (blank)
Signed/Address: Dr. W. L. Stumbo, M.D., 11 February
1917, Weeksbury
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Beaver, Ky.
Date of Burial: 13 January 1917
Undertaker/Address: Edward Gayheart, Weeksbury, Ky.
Transcribed by Debbie Tamborski, 28 February 2010 |
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