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DEATH
CERTIFICATE
CAROLINE GIBSON
Date 25 July 1940
Cert: 19750
Place of Death: Voting Pct.: Mousie, Knott Co., Ky.
Full Name: Caroline GIBSON
Residence: Mousie
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White,
Widowed
Husband or Wife of: (blank)
Date of Birth: (blank)
Age: 90 years, 02 months, 10 days
Occupation: Housewife
Birthplace: Knott Co.
Father Name: William FULTZ
Birthplace Father: Kentucky
Mother Maiden Name: Artie FULTZ
Birthplace Mother: Kentucky
Informant/Address: Mrs. Theo (illegible), Paintsville
Burial Cremation Removal Place: Lackey
Date: 26 July 1940
Undertaker/Address: (illegible) Preston, Paintsville, Ky.
Filed: 30 August 1940
Registrar: Macie Miller
Death of Date: 25 July 1940
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: Pneumonia
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: J. W. Duke, Hindman, Ky.
Transcribed by Debbie Tamborski, 17 August 2010 |
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