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DEATH
CERTIFICATE
RILEY H. MILLARD
Date: 29 December 1940
Cert: 02295
Place of Death: County: Knott City or Town:
Sassafras
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: Sassafras
Full Name: Riley H. MILLARD
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Belle C. MILLARD
Age of husband or wife if alive: 73 years
Birth date of deceased: 20 September 1858
Age: 82 years
Birthplace: Tennessee
Occupation: Farmer
Industry or business: (blank)
Father Name: William MILLARD
Father Birthplace: Tenn.
Mother Maiden Name: Elizabeth PATTON
Mother Birthplace: Tenn.
Informant/Address: Mrs. E. M. COMBS, Allock, Ky.
Burial Place: Vicco, Ky.
Date: 30 December 1940
Signature of funeral director/address: family
Date received by local registrar: 23 January 1941
Registrar's Signature: Macie Miller
Date of Death: 29 December 1940
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: Senility
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: C. L. Combs, M.D., Cordia, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 28 August 2010 |
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