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DEATH
CERTIFICATE
EVA NICKLES MULLINS
Date: 02 September 1940
Cert: 26568
Place of Death: County: Knott City or Town:
Hindman
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: Hindman
Full Name: Eva NICKLES MULLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Arlie MULLINS
Age of husband or wife if alive: 29 years
Birth date of deceased: 26 June 1907
Age: 37 years
Birthplace: Knott Co.
Occupation: House wife
Industry or business: (blank)
Father Name: Maston NICKLES
Father Birthplace: Dobson, North Carolina
Mother Maiden Name: Eliza BREWER
Mother Birthplace: Hazard, Kentucky
Informant/Address: Amos NICKLES, Hindman, Kentucky
Burial Place: Nickles Cemt.
Date: 04 September 1940
Signature funeral director/address: Louis Nickles, Hindman,
Ky.
Date received by local registrar: 09 September 1940
Registrar's Signature: Macie Miller
Date of Death: 02 September 1940
I hereby certify that I attended deceased from 02 September
1940 to
02 September 1940, that I last saw him alive on 02 September
1940, and that death occurred on the date stated above at 7
a.m.
Immediate cause of death: Seticema & heart failure
Duration: (blank)
Due to: Child Birth
Major findings of operations: None Of
Autopsy: None
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: M. F. Kelley, Hindman, Ky.
Date signed: 02 September 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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