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DEATH
CERTIFICATE
EDAN JEAN ROBINSON
Date: 23 September 1940
Cert: 02311
Place of Death: County: Knott City or Town: Handshoe
(Rural)
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: Handshoe, Ky., Rural
Full Name: Edan Jean ROBINSON
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: 11 August 1940
Age: 01 months, 12 days
Birthplace: Handshoe
Occupation: none
Industry or business: none
Father Name: Estill ROBINSON
Father Birthplace: Elmrock, Ky.
Mother Maiden Name: Sadie HANDSHOE
Mother Birthplace: Handshoe, Ky.
Informant/Address: Estill ROBINSON, Yellow Mountain, Ky.
Burial Place: Yellow Mt., Ky.
Date: 24 September 1940
Signature of funeral director/address: family
Date received by local registrar: 22 January 1941
Registrar's Signature: Macie Miller
Date of Death: 23 September 1940
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 (blank)
Immediate cause of death: Double pneumonia and whooping cough
Duration: (blank)
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: Alafair Cox, Yellow Mt.
Date signed: (blank)
Transcribed by Debbie Tamborski, 28 August 2010 |
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