Date: 28 April 1945
Cert: 04588
Place of Death: County: Knott City or
Town: Pippapass, Ky. Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: (blank)
Full Name: Mary JOHNSON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Widow
Husband or Wife of: Abisha JOHNSON
Age of husband or wife if alive: Deceased
Birth date of deceased: 13 December 1878
Age: 66 years, 04 months, 15 days
Birthplace: Knott Co., Ky.
Occupation: House wife
Industry or business: (blank)
Father Name: James P. SLONE
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Katherine SLONE
Mother Birthplace: Knott Co., Ky.
Informant: Susie J. SLONE, Pippapass
Burial Place: Jimmy Slone Cem.
Date: 29 April 1945
Signature of funeral director: None
Date received by local registrar: 16 January 1946
Registrar's Signature: Rose B. Craft
Date of Death: 28 April 1945
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: Pneumonia
Duration: (blank)
Due to: Cold
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: J. W. Duke, M.D., Hindman
Date signed: 28 January 1946
Transcribed by Debbie Tamborski, 29 November 2010 |