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DEATH
CERTIFICATE
POLLY MADDEN
Date 23 February 1920
Cert: 05627
Place of Death: Voting Precinct: #16 Berea, Madison Co.,
Ky.
Full Name: Polly MADDEN
Sex, Color or Race, Marital Status: Female, White,
Single
Date of Birth: 02 July 1896
Age: 23 years
Occupation: Student
Birthplace: Knott Co., Ky.
Name of Father: John MADDEN
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Isabel STAMPER
Birthplace Mother: Knott Co., Ky.
Informant/Address: Isabel MADDEN, Sittsboro, Ky. [sic]
Filed: 24 February 1920
Registrar: J. F. Dean
Death Date: 23 February 1920
I hereby certify that I attended deceased from 18 February
1920, to
23 February 1920, that I last saw her alive on 23 February
1920, and that death
occurred, on the date stated above, at 10 a.m.
Cause of Death: Broncho Pneumonia
Duration: 08 days
Contributory: (blank)
Signed/Address: M. M. Roberson, M.D., 23
February 1920, Berea
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: R. H. (illegible), Berea, Ky.
Transcribed by Debbie Tamborski, 06 March 2010 |
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