Date: 03 February 1943
Cert: 15267
Place of Death: County: Knott City or
Town: Smithsboro
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Smithsboro
Full Name: Mrs. Dora SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widow
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 1880
Age: 63 years
Birthplace: Dewitt, Ky.
Occupation: Hswf.
Industry or business: (blank)
Father Name: WILLIAMSON
Father Birthplace: Dewitt, Ky.
Mother Maiden Name: (blank)
Mother Birthplace: (blank)
Informant: Albert SMITH, Cody, Ky.
Burial Place: Dewitt, Ky.
Date: 05 February 1943
Signature of funeral director: Family and friends, Dewitt, Ky.
Date received by local registrar: 18 June 1945
Registrar's Signature: Mrs. Rose B. Craft, Acting, Per
B.Carns
Date of Death: 03 February 1943
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Gallstone colic
Duration: (blank)
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: H. D. Duff, M.D.
Date signed: 16 June 1945
Transcribed by Debbie Tamborski, 27 October 2010 |