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DEATH
CERTIFICATE
ROSE ANNA HENSLEY
Date 17 July 1934
Cert: 15983
Place of Death: Voting Pct.: Rousseau, Breathitt Co.,
Ky.
Full Name: Rose Anna HENSLEY
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Jackson HENSLEY
Date of Birth: 10 June 1876
Age: 64 years, 01 months, 07 days
Occupation: Housewife
Birthplace: Knott Co., Ky.
Father Name: Henry SHEPHERD
Birthplace Father: Knott Co., Ky.
Mother Maiden Name: not known
Birthplace Mother: Knott Co., Ky.
Informant/Address: Jack LOVELY, Rousseau, Ky.
Filed: 18 July 1934
Registrar: G. P. Back
Death Date: 17 July 1934
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: Dropsy
Duration: 01 year
Contributory: (blank)
Signed/Address: (blank)
Length of residence at place of death: (blank)
Where was disease contracted if not at place of death?:
(blank)
Place of Burial or Removal: Hensley Graveyard
Date of Burial: (blank)
Undertaker/Address: Martha Day, Rousseau, Ky.
Transcribed by Debbie Tamborski, 05 April 2010 |
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