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DEATH
CERTIFICATE
MELBA HICKS
Date 24 July 1940
Cert: 02310
Place of Death: County: Knott City or Town:
Lackey
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Hippo Rural
Full Name: Melba HICKS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 August 1923
Age: 16 years, 11 months, 15 days
Birthplace: Floyd Co., Ky.
Occupation: Student
Industry or business: (blank)
Father Name: Ruben M. HICKS
Father Birthplace: Pyramid, Ky.
Mother Maiden Name: Artie ALLEN
Mother Birthplace: Langley, Ky.
Informant/Address: Ruben HICKS, Hippo, Ky.
Burial Place: Hippo, Ky.
Date: 26 July 1940
Signature of funeral director/address: none
Date received by local registrar: 28 January 1941
Registrar's Signature: Macie Miller
Date of Death: 24 July 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 9:00 p.m.
Immediate cause of death: Appendicitis
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: W. L. Stumbo, Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 18 August 2010 |
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