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DEATH
CERTIFICATE
Mrs. MARY SMITH
Date 13 December 1918
Cert: 13017
Place of Death: Voting Precinct: No. 1, Garrard, Clay
Co., Ky.
Full Name: Mrs. Mary SMITH
Sex, Color or Race, Marital Status: Female, White,
Married
Date of Birth: 03 April 1888
Age: 30 years
Occupation: Housewife
Birthplace: Knott Co., Ky.
Name of Father: W. P. CODY
Birthplace Father: Knott Co., Ky.
Maiden name of Mother: Elizabeth COMBS
Birthplace Mother: Knott Co., Ky.
Informant/Address: Mrs. Elizabeth CODY, Garrard, Ky.
Filed: 09 January 1919
Registrar: Mrs. Wm. Rice by Wm. Rice
Death Date: 13 December 1918
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw her alive on 13 December 1918, and
that death occurred, on the date stated above, at 5 a.m.
Cause of Death: Pneumonia (Broncho) following influenza
and (illegible) before death
Duration: (blank)
Contributory: (blank)
Signed/Address: J. L. Anderson,
M.D., 14
December 1918, Manchester, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Clay Co., Ky.
Date of Burial: (illegible) December 1918
Undertaker/Address: Ed Garrard, Garrard, Ky.
Transcribed by Debbie Tamborski, 05 March 2010 |
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