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DEATH
CERTIFICATE
EDITH SMITH
Date 14 June 1943
Cert: 13107
Place of Death: County: Floyd City or
Town: Martin
Name of Hospital or Institution: Martin General
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Elm Rock
Full Name: Edith SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of: Silas
Age of husband or wife if alive: 52
Birth date of deceased: 14 January 1901
Age: 42 years, 05 months
Birthplace: Breathitt Co.
Occupation: domestic
Industry or business: (blank)
Father Name: Newton WIREMAN
Father Birthplace: Knott Co.
Mother Maiden Name: Dorothy HOWARD
Mother Birthplace: Menifee Co.
Informant: Silas SMITH, Elm Rock, Ky.
Burial Place: Elm Rock, Ky.
Date: 15 June 1943
Signature of funeral director: W. J. Ryan, Martin, Ky.
Date received by local registrar: 30 June 1943
Registrar's Signature: Winifred Norris
Date of Death: 14 June 1943
I hereby certify that I attended deceased from 04 June 1943 to
14 June 1943, that I
last saw him alive on14 June 1943, and that death occurred on the date
stated above at 10 p.m.
Immediate cause of death: (blank)
Due to: Rheumatic heart disease
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: C. L. Allen, M.D., Martin, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 06 February 2010 |
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