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DEATH
CERTIFICATE
MOLLIE GOODMAN
Date 04 December 1940
Cert: 29249
Place of Death: County: Knott Co. City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Mem. Hosp.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Garrett, Ky.
Full Name: Mollie GOODMAN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Buck GOODMAN
Age of husband or wife if alive: (blank)
Birth date of deceased: 26 December 1865
Age: 74 years, 11 months, 20 days
Birthplace: Johnson Co., Ky.
Occupation: Domestic
Industry or business: (blank)
Father Name: Frank CENTERS
Father Birthplace: Johnson Co.
Mother Maiden Name: Martha McCARTY
Mother Birthplace: Johnson Co.
Informant/Address: Charlie GOODMAN, Garrett
Burial Place: Garrett, Ky.
Date: 08 December 1940
Signature of funeral director/address: W. J. Ryan, Martin, Ky.
Date received by local registrar: 13 December 1940
Registrar's Signature: Macie Miller
Date of Death: 04 December 1940
I hereby certify that I attended deceased from 04 December
1940 to
04 December 1940, that I last saw her alive on 04 December
1940, and that death occurred on the date stated above at 3
p.m.
Immediate cause of death: Myocarditis
Duration: (blank)
Due to: Hypertension
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: W. L. Stumbo, Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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