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DEATH
CERTIFICATE
MAGGIE MOLLITT
Date: 20 June 1940
Cert: 15191
Place of Death: County: Knott Co. 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:
Floyd
City or Town: Minnie, Ky. Street
No.: Rural
Full Name: Maggie MOLLITT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 04 January 1934
Age: 06 years, 05 months, 16 days
Birthplace: Minnie, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Eligah MOLLITT
Father Birthplace: Johnson Co.
Mother Maiden Name: Alma DANIEL
Mother Birthplace: Johnson Co.
Informant/Address: Alma MOLLITT, Minnie, Ky.
Burial Place: Boons Camp, Ky.
Date: 21 June 1940
Signature of funeral director/address: W. J. Ryan,
Martin, Ky.
Date received by local registrar: 28 June 1940
Registrar's Signature: Macie Miller
Date of Death: 20 June 1940
I hereby certify that I attended deceased from 19 June 1940 to
20 June 1940, that I last saw him alive on 20 June 1940, and
that death occurred on the date stated above at 9:45 a.m.
Immediate cause of death: (blank)
Duration: (blank)
Due to: Cerebro Spinal Meningitis (illegible)
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: R. A. Thompson, M.D., Stumbo
Memorial Hospital, Lackey, Ky.
Date signed: 20 June 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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