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DEATH
CERTIFICATE
SUSAN GREEN
Date 14 April 1911
Cert: 08794
Place of Death: Voting Precinct: Jackson, Breathitt Co.,
KY
Full Name: Susan GREEN
Sex, Color or Race, Marital Status: (blank)
Date of Birth: (blank)
Age: 45 years
Occupation: (blank)
Birthplace: Knott Co., KY
Name of Father:
Don't know
Birthplace Father:
" "
Maiden name of Mother: "
"
Birthplace Mother: Knott Co., KY
Informant/Address: (blank)
Filed: 10 May 1911
Registrar: J. R. Blake
Death Date: 14 April 1911
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: Consumption. Bedfast about 02
months
Duration: (blank)
Contributory: (blank)
Signed/Address: Minerva Hagins
Place of Burial or Removal: (blank)
Date of Burial: 15 April 1911
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 23 February 2010 |
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