Date:   03 February 1943
Cert:   15307
Place of Death: County: Knott     City or Town: Smithsboro
Street No. or Location:  Smiths Branch
Length of stay in hospital or community: 01 year
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.: None
Sex, Color or Race, Marital Status: Female, White
Husband or Wife of:  Widow
Age of husband or wife if alive: (blank)
Birth date of deceased: unknown 1880
Age: (blank)
Birthplace:  Dewitt, Ky.
Occupation:  Housewife
Industry or business: none
Father Name:  Mrs. Dora SMITH
Father Birthplace:  Dewitt, Ky.
Mother Maiden Name:  Dora WILLIAMSON
Mother Birthplace:  Dewitt, Ky.
Informant:  Albert SMITH, Cody, Ky.
Burial Place: Dewitt, Ky.
Date:  February 1943
Signature of funeral director: (blank)
Date received by local registrar:  (blank)
Registrar's Signature:  (blank)
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:  (blank)
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: (blank)
Date signed:  (blank)
Transcribed by Debbie Tamborski, 27 October 2010