Date: 27 September 1942
Cert: 22715
Place of Death: County: Knott Co. City or
Town: Rural
Name of Hospital or Institution: none
Length of stay in hospital or community: 01 year, 06 months
Usual Residence of Deceased: State: Kentucky County:
Knott Co.
City or Town: Mallie Rural
Full Name: Millard SEXTON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 01 October 1899
Age: 43 years
Birthplace: Knott Co., Ky.
Occupation: None
Industry or business: None
Father Name: Dock SEXTON
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Eliza Jane LUCAS
Mother Birthplace: Letcher Co., Ky.
Informant: Eliza Jane SHORT, Mallie, Ky.
Burial Place: Mallie, Ky.
Date: 28 September 1942
Signature of funeral director: none family, Mallie
Date received by local registrar: 10 October 1942
Registrar's Signature: Ida Livingston
Date of Death: 27 September 1942
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: Not known to be sure but appeared to
be consumption
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: Eliza JANE SHORT, Mallie
Date signed: 29 September 1942
Transcribed by Debbie Tamborski, 18 October 2010 |