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DEATH
CERTIFICATE
MANDA GREEN
Date 02 December 1940
Cert: 10607
Place of Death: County: Knott City or Town:
Elmrock (rural)
Name of Hospital or Institution: none
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Elmrock (rural)
Full Name: Manda GREEN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widow
Husband or Wife of: John GREEN
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 June 1862
Age: 78 years, 11 months, 27 days
Birthplace: Elmrock, Kentucky
Occupation: none
Industry or business: none
Father Name: Brice SHEPHERD
Father Birthplace: Elmrock
Mother Maiden Name: Nancy SHEPHERD
Mother Birthplace: Elmrock
Informant/Address: Billie GREEN, Yellow Mountain, Ky.
Burial Place: Elmrock, Ky.
Date: 03 December 1941 (transcribed as written)
Signature of funeral director/address: (blank)
Date received by local registrar: 08 April 1941
Registrar's Signature: Macie Miller
Date of Death: 02 December 1940
I hereby certify that I attended deceased from (blank) 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: Old age
Duration: (blank)
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 & Address: Alafair Cox, Yellow Mt.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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