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DEATH
CERTIFICATE
MINNIE SHEPHERD
Date 21 February 1916
Cert: 14212
Place of Death: Voting Precinct: #9, Breathitt Co., Ky.
Full Name: Minnie SHEPHERD
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: 20 December 19(illegible)
Age: years, months (blank)
Occupation: (blank)
Birthplace: Knott
Name of Father: George SHEPHERD
Birthplace Father: Knott Co.
Maiden name of Mother: Alice BRADLEY
Birthplace Mother: Knott Co.
Informant/Address: Bill MULLINS, Decoy
Filed: (illegible)
Registrar: Ada S. Carpenter L. Carpenter
Death Date: 21 February 1916
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: (blank)
Duration: (blank)
Contributory: (blank)
Signed/Address: (blank)
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Preso Bradley G V Y
Date of Burial: 23 February 1916
Undertaker/Address: George Shepherd, Lambric
Transcribed by Debbie Tamborski, 26 February 2010 |
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