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DEATH
CERTIFICATE
MARRY MINTER
Date: 13 September 1940
Cert: 21961
Place of Death: County: Knott Co. City or Town:
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town:
Full Name: Marry MINTER
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, (illegible)
Husband or Wife of: (illegible)
Age of husband or wife if alive: (illegible)
Birth date of deceased: 06 December 1879
Age: 61 years, 09 months, 07 days
Birthplace: Virginia
Occupation: Domestic
Industry or business: (blank)
Father Name: ? PURDY [sic}
Father Birthplace: Virginia
Mother Maiden Name: Don't know
Mother Birthplace:
Informant/Address: M. M. Meade, Estill, Ky.
Burial Place: Louisa, Ky.
Date: 15 September 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 30 September 1940
Registrar's Signature: Macie Miller
Date of Death: 13 September 1940
I hereby certify that I attended deceased from (illegible) to
(illegible), that I last saw him alive on (illegible), and
that death occurred on the date stated above at 6:00 a.m.
Immediate cause of death: Broncho Pneumonia
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: W. L. Stumbo, Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 28 August 2010 |
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