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DEATH
CERTIFICATE
JAQUELINE MULLINS
Date 16 April 1943
Cert: 08354
Place of Death: County: Floyd City or Town:
Fed
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Dema
Full Name: Jaqueline MULLINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Child
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 24 February 1941
Age: 02 years, 01 months, 23 days
Birthplace: Dema, Ky.
Occupation: child
Industry or business: (blank)
Father Name: Dewey MULLINS
Father Birthplace: Dema, Ky.
Mother Maiden Name: Elsie MEADE
Mother Birthplace: Dema, Ky.
Informant: Willard MULLINS, Dema, Ky.
Burial Place: Dema, Ky.
Date: 18 April 1943
Signature of funeral director: Ryan Funeral Home, Martin, Ky.
Date received by local registrar: 24 April 1943
Registrar's Signature: Winifred Norris
Date of Death: 16 April 1943
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at 1:30 p.m.
Immediate cause of death: Pneumonia
Duration: (blank)
Due to: (blank)
Other Conditions: (?following pertussis?)
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. S. Osborne, Bypro
Date signed: 20 April 1943
Transcribed by Debbie Tamborski, 31 May 2010 |
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