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DEATH
CERTIFICATE
SARAH JANE REFFETT
Date 18 May 1941
Cert: 14508
Place of Death: County: Floyd City or Town:
Pyramid
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: Floyd
City or Town: Pyramid If rural
precinct: Middle Creek 5
Full Name: Sarah Jane REFFETT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widow
Husband or Wife of: John
Age of husband or wife if alive: (blank)
Birth date of deceased: 22 February 1884
Age: 67 years, 02 months, 26 days
Birthplace: Knott County, Ky.
Occupation: House wife
Industry or business: (blank)
Father Name: Ashland CONLEY
Father Birthplace: Knott County, Ky.
Mother Maiden Name: Jessie Ann PARKER
Mother Birthplace: Knott County
Informant: H. H. REFFETT, Pyramid, Ky.
Burial Place: Pyramid
Date: 20 May 1941
Signature of funeral director: E. P. Arnold, Prestonsburg
Date received by local registrar: 12 June 1941
Registrar's Signature: Mrs. Ben Norris
Date of Death: 18 May 1941
I hereby certify that I attended deceased from 15 January 1941 to
1941, that I last saw her alive on about 01 February 1941, and
that death occurred on the date stated above at ? [sic]
Immediate cause of death: Pulmonary Tuberculosis
Duration: ? [sic]
Due to: (blank)
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: D. H. Daniel,
M.D., West Prestonsburg, Ky.
Date signed: 11 June 1941
Transcribed by Debbie Tamborski, 14 May 2010 |
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