Date: 05 March 1948
Cert: 05958
Place of Death: County: Knott City or
Town: Rural
Street Number or Location: Big Branch
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural If rural
give precinct: Big Branch
Full Name: Eliza NICHOLS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 76 years
Birthplace: Perry Co., Ky.
Occupation: House Keeper
Industry or business: (blank)
Father Name: Jack BREWER
Father Birthplace: Ky.
Mother Maiden Name: ? (transcribed as written)
Mother Birthplace: (blank)
Informant: Amos NICHOLS, Hindman, Ky.
Burial Place: Big Branch
Date: 06 March 1948
Signature of funeral director: Joe Greer, Hazard, Ky.
Date received by local registrar: 09 March 1948
Registrar's Signature: Rose B. Craft
Date of Death: 05 March 1948
I hereby certify that I attended deceased from 01 September
1947 to
04 March 1948, that I last saw him alive on 04 March 1948, and that death
occurred on the date stated above at (blank)
Immediate cause of death: cerebral hemorrhage with rt.
hemiplegia & aphasia with dysphagia
Duration: 06 days
Due to: Hypertension and arteriosclerosis
Other conditions: Hypertensive and arteriosclerotic
heart disease
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: D. G. Barker, M.D., Hindman,
Ky.
Date signed: 09 March 1948
Transcribed by Debbie Tamborski, 28 December 2010 |