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DEATH
CERTIFICATE
Mrs. CORNELIA SHEPHERD
Date 13 February 1931
Cert: 05915
Place of Death: Voting Pct: #1 Jackson, Breathitt Co.,
Ky.
Full Name: Mrs. Cornelia SHEPHERD
Residence: (blank)
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Charley SHEPHERD
Date of Birth: 13 January 1896
Age: 35 years, 01 months
Occupation: Housewife
Birthplace: Knott Co.
Father Name: John PARKS
Birthplace Father: Virginia
Mother Maiden Name: Sarah TRENT
Birthplace Mother: Kentucky
Informant/Address: Charley SHEPHERD, Clayhole
Filed: 28 February 1931
Registrar: Irene Hoge
Death of Date: 13 February 1931
I hereby certify that I attended deceased from 06 February
1931 to
13 February 1931, that I last saw her alive on 12 February
1931, and that death
occurred on the date stated above at 2:15 a.m.
Cause of Death: Traumatic fracture of right clavicle and
fracture at base skull
Duration: 07 days
Contributory: (blank)
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: No Date: (blank)
Was there an autopsy: No
What test confirmed diagnosis: (blank)
Signed/Address: J. C. McGuire, M.D., 13
February 1931, Jackson, Ky.
Place of Burial or Removal: Clayhole
Date of Burial: 14 February 1931
Undertaker/Address: Don't know
Transcribed by Debbie Tamborski, 31 March 2010 |
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