|
DEATH
CERTIFICATE
SALLIE SHEPPARD
Date: 18 February 1940
Cert: 10426
Place of Death: County: Knott City or Town:
Lackey
Name of Hospital or Institution: Stumbo Memorial
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Pyramid
Full Name: Sallie SHEPPARD
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Abe SHEPPARD
Age of husband or wife if alive: 54 years
Birth date of deceased: Don't know
Age: 50 years
Birthplace: Floyd Co., Ky.
Occupation: House
Industry or business: (blank)
Father Name: Harrison STEPHENS
Father Birthplace: Floyd Co.
Mother Maiden Name: Rebecca ALLEN
Mother Birthplace: Floyd Co.
Informant/Address: Abe SHEPHERD, Pyramid, Ky.
Burial Place: Pyramid
Date: 20 February 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 07 March 1940
Registrar's Signature: Macie Miller
Date of Death: 18 February 1940
I hereby certify that I attended deceased from (blank) to
18 February 1940, that I last saw her alive on (blank), and
that death occurred on the date stated above at 4:45 a.m.
Immediate cause of death: Strephococcic meningitis
Duration: (blank)
Due to: Otitis media and mastoiditis ex???sion
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: A. Rabin, M.D., Martin
Date signed: (blank)
Transcribed by Debbie Tamborski, 28 August 2010 |
|