Date: 23 April 1941
Cert: 15469
Place of Death: County: Knott City or
Town: Elmrock
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Knott
City or Town: Elmrock
Full Name: Martha PATRICK
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 22 April 1941
Age: 03 hours
Birthplace: Elmrock, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Aster PATRICK
Father Birthplace: Vest, Ky.
Mother Maiden Name: Clara FITCH
Mother Birthplace: Elmrock, Ky.
Informant: Alafair COX, Yellow Mountain, Ky.
Burial Place: Baker
Date: 24 April 1941
Signature of funeral director: none
Date received by local registrar: 09 June 1941
Registrar's Signature: Macie Miller
Date of Death: 23 April 1941
I hereby certify that I attended deceased from 22 April 1941 to
23 April 1941, that I last saw h-- alive on 23 April 1941, and
that death occurred on the date stated above at 1:00 o'clock
a.m.
Immediate cause of death: Premature birth
Duration: (blank)
Due to: unknown
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: Alafair Cox, Yellow Mountain,
Ky.
Date signed: 02 June 1941
Transcribed by Debbie Tamborski, 14 October 2010 |