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DEATH
CERTIFICATE
ELLA MAZE SIZEMORE
Date 18 June 1916
Cert: 16970
Place of Death: Voting Precinct: Hazard, Perry Co., Ky.
Full Name: Ella Maze SIZEMORE
Sex, Color or Race, Marital Status: Female, White,
Single
Date of Birth: 13 April 1901
Age: 15 years, 02 months, 05 days
Occupation: Schoolwork
Birthplace: Knot County
Name of Father: Spike SIZEMORE
Birthplace Father: Leslie County
Maiden name of Mother: Jane CORNETT
Birthplace Mother: Perry County
Informant/Address: (blank)
Filed: 05 August 1916
Registrar: G. (illegible)
Death Date: 18 June 1916
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw her alive on 18 June 1916, and that
death occurred, on the date stated above, at 5:30 p.m.
Cause of Death: Bacillary dysentery
Duration: 05 days
Contributory: (blank)
Signed/Address: Morgan G. W., M.D., 19
June 1916, Hazard, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 26 February 2010 |
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