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DEATH
CERTIFICATE
SURILDIA MCDANIELS
Date 28 November 1943
Cert: 02802
Place of Death: County: Perry City or Town:
Rural
Street No. or Location: Home
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural
Full Name: Surildia MCDANIELS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White
Husband or Wife of: Chester MCDANIELS
Age of husband or wife if alive:
Birth date of deceased: 28 November 1867
Age: 76 years, 10 months, 22 days, 09 hours, 15 minutes
Birthplace: Knott Co.
Occupation: Housewife
Industry or business: (blank)
Father Name: Clayborn HICKS
Father Birthplace: Knott Co.
Mother Maiden Name: unknown
Mother Birthplace:
"
Informant: Chester MCDANIELS, Lothair, Ky.
Burial Place: (?Ferry Toy? illegible)
Date: 29 November 1943
Signature funeral director: Maggard Funeral Home, Hazard, Ky.
Date received by local registrar: 31 January 1944
Registrar's Signature: Anna L. Boulos
Date of Death: 28 November 1943
I hereby certify that I attended deceased from (illegible) to
(November 1943), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Cancer of womb
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: J. W. Duke, Hindman, Ky.
Date signed: 21 January 1944
Transcribed by Debbie Tamborski, 31 May 2010 |
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