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DEATH
CERTIFICATE
MARY SMITH
Date 15 March 1922
Cert: 06081
Place of Death: Voting Precinct: Asylum, E. State Hospital,
Fayette Co., Ky.
Full Name: Mary SMITH
Sex, Color or Race, Marital Status: Female, White, Married
Date of Birth: no record
Age: 32 years
Occupation: Housewife
Birthplace: Knott Co., Ky.
Name of Father: Leslie SHEPHERD
Birthplace Father: Ky.
Maiden name of Mother: Louisa MORGAN
Birthplace Mother: Ky.
Informant/Address: State Hospital Records, Lex., Ky.
Filed: 19 March 1922
Registrar: (illegible)
Death Date: 15 March 1922
I hereby certify that I attended deceased from 05 February
1922, to 15 March 1922, that I last saw her alive on 15 March
1922, and that death occurred, on the date stated above, at 10
a.m.
Cause of Death: Exhaustion from manic depressive psychosis
Duration: 02 months
Contributory: (blank)
Signed/Address: M. C. Dunlop, M.D., Lex., Ky.
Length of residence at place of death: 01 months 10 days
In state: 32 years
Where was disease contracted if not at place of death: At home
Former or usual residence: Knott Co., Ky.
Place of Burial or Removal: Eastern State Hospital
Date of Burial: 17 March 1922
Undertaker/Address: E. S. Hosp., Lex, Ky.
Transcribed by Debbie Tamborski, 19 March 2010 |
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