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DEATH
CERTIFICATE
HAZEL MULLINS
Date: 05 March 1940
Cert: 17487
Place of Death: County: Knott City or Town:
Amburgey
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: (blank) Street No.:
Amburgey
Full Name: Hazel MULLINS
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: 18 January 1923
Age: 17 years
Birthplace: Knott
Occupation: School girl
Industry or business: (blank)
Father Name: Newton J. MULLINS
Father Birthplace: Knott
Mother Maiden Name: Lizzie GIBSON
Mother Birthplace: Knott
Informant/Address: Lizzie MULLINS, Amburgey, Ky.
Burial Place: Brinkley
Date: 07 March 1940
Signature of funeral director/address: family, Amburgey
Date received by local registrar: 12 July 1940
Registrar's Signature: Macie Miller
Date of Death: 05 March 1940
I hereby certify that I attended deceased from 04 March 1940 to
saw one time only, that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: (blank)
Duration: (blank)
Due to: Lobar pneumonia
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: Guy C. Pinckley, M.D., Anco, Ky.
Date signed: 25 June 1940
Transcribed by Debbie Tamborski, 28 August 2010 |
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