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DEATH
CERTIFICATE
AMERICA MULLINS
Date 03 September 1917
Cert: 24303
Place of Death: Voting Precinct: Springfork, Breathitt
Co., Ky.
Full Name: America MULLINS
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: (blank)
Age: years, months (blank)
Occupation: (blank)
Birthplace: Knott Co.
Name of Father: Booker MULLINS
Birthplace Father: Knott Co.
Maiden name of Mother: Margarett BARNETT
Birthplace Mother: Breathitt Co.
Informant/Address: Booker MULLINS, Lambric
Filed: 04 September 1917
Registrar: A. D. Carpenter
Death Date: 03 September 1917
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: Cancer
Duration: (blank)
Contributory: (blank)
Signed/Address: (blank)
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Press Bradley Cem.
Date of Burial: 05 September 1917
Undertaker/Address: Booker Mullins, Lambric
Transcribed by Debbie Tamborski, 28 February 2010 |
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