DEATH CERTIFICATE
MAXIN KELLEY

Date    09 November 1915
Deathvol Vol:   1915
Cert: #  27538
Name:  Maxin KELLEY
Female, White
Age:  5 years, 7 months, 11 days
Place of Death: Voting Pct. No. 6, Smithsboro, Knott Co., KY
Birth Date:  29 March 1910                          
Place of Birth:  Knott, Ky.
Father:  George KELLEY                                               Birthplace Father:  Knott Co., Ky.
Mother:  Dicy ADAMS                                                       Birthplace Mother:  Knott Co., Ky.
Informant:  Thomas KELLEY, Smithsboro, Ky.
Death Date:  09 November 1915
Cause of Death:  acute dysentery
Signed:  F. C. Roark, M.D.
Burial Place:  Geo. Kelley
Undertaker:  Geo. Kelley, Smithsboro, Ky.
File Date: 10 November 1915
Transcribed by Debbie Tamborski, 03 August 2008