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DEATH
CERTIFICATE
MINERVA SIZEMORE
Date 19 December 1940
Cert: 28210
Place of Death: County: Floyd City or Town: Water Gap (Rural)
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky County:
Floyd
City or Town: Water Gap (rural)
Street No.: James Banks
Full Name: Minerva SIZEMORE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 30 October 1866
Age: 74 years, 01 months, 20 days
Birthplace: Knott County (transcriber note--Floyd
crossed out)
Occupation: Housekeeper
Industry or business: (blank)
Father Name: William SIZEMORE
Father Birthplace: Floyd County
Mother Maiden Name: Sallie SLOAN
Mother Birthplace: Knott County
Informant: Ernest REYNOLDS, Water Gap, Ky.
Burial Place: Water Gap, Ky.
Date: 21 December 1940
Signature of funeral director: E. P. Arnold,
Prestonsburg, Ky.
Date received by local registrar: 31 December 1940
Registrar's Signature: Mrs. Ben Norris
Date of Death: 19 December 1940
I hereby certify that I attended deceased from 19 December
1940 to
19 December 1940, that I last saw her alive on 19 December
1940, and that death occurred on the date stated above at 11
p.m. Saw her once only.
Immediate cause of death: Pneumonia
Duration: ? [sic]
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: D.H. Daniel, MD, West
Prestonsburg, Ky.
Date signed: 30 December 1940
Transcribed by Debbie Tamborski, 10 May 2010 |
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