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DEATH
CERTIFICATE
SALLIE ANN MARTIN
Date: 26 March 1940
Cert: 10413
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:
Knott
City or Town: Mousie, Ky.
Full Name: Sallie ANN MARTIN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Fed MARTIN
Age of husband or wife if alive: 63 years
Birth date of deceased: 10 March 1879
Age: 61 years, 00 months, 11 days
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: Domistic [sic]
Father Name: John HUFF
Father Birthplace: Knott Co.
Mother Maiden Name: Jane TERRY
Mother Birthplace: Knott
Informant/Address: Bee MARTIN, Mousie, Ky.
Burial Place: Mousie
Date: 27 March 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 30 March 1940
Registrar's Signature: Macie Miller
Date of Death: 26 March 1940
I hereby certify that I attended deceased from 16 March 1940 to
26 March 1940, that I last saw him alive on 26 March 1940, and
that death occurred on the date stated above at 9:40 a.m.
Immediate cause of death: Diabetes mellitus
Duration: 30 years
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: C. B. Ison, Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 27 August 2010 |
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