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DEATH
CERTIFICATE
BEATREICE MONTGOMERY
Date: 14 September 1940
Cert: 21960
Place of Death: County: Knott Co. City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Pike
City or Town: Millard, Ky.
Street No.: Rural
Full Name: Beatreice MONTGOMERY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Jeff MONTGOMERY
Age of husband or wife if alive: (blank)
Birth date of deceased: 12 March 1913
Age: 27 years, 06 months, 02 days
Birthplace: White House, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Luke BOOTHE
Father Birthplace: Johnson
Mother Maiden Name: Nan BOOTHE
Mother Birthplace: Johnson Co.
Informant/Address: Ann MCDONELL, Pikeville
Burial Place: White House, Ky.
Date: 16 September 1940
Signature of funeral director/address: W. J. Ryan, Martin, Ky.
Date received by local registrar: 30 September 1940
Registrar's Signature: Macie Miller
Date of Death: 14 September 1940
I hereby certify that I attended deceased from 07 September
1940 to
14 September 1940, that I last saw him alive on 14 September
1940, and that death occurred on the date stated above at 8:10
a.m.
Immediate cause of death: (illegible) Uremic poison
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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