Date:    06 October 1948
Cert:    23452 
Place of Death: County: Knott  City or Town: Mousie, Ky. Rural
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky   County: Knott
City or Town:  Mousie     Rural 
Full Name:  Rosa STURGILL SMITH 
If Veteran Name War: (blank)
Social Security No.:  (blank)
Sex, Color or Race, Marital Status: Female, White, Married 
Husband or Wife of:  John B. SMITH
Age of husband or wife if alive: 68 years
Birth date of deceased:  18 January 1887 
Age:  61 years, 08 months, 18 days
Birthplace:  Balls Fork, Knott Co. 
Occupation:  Housewife 
Industry or business:  Housekeeping
Father Name: Charles STURGILL 
Father Birthplace:  Knott Co., Ky. 
Mother Maiden Name:  Francis THOMAS 
Mother Birthplace:  Knott Co.-Carrs Fork 
Informant:  Mrs. Hettie S. HAYS, Mousie, Ky. 
Burial Place:   Combs Cem. 
Date:  09 October 1948 
Signature of funeral director:  G. D. Ryan, Martin, Ky.
Date received by local registrar: 19 November 1948 
Registrar's Signature:  Rose B. Craft
Date of Death:  06 October 1948 
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:  Shock due to blood loss
Duration: (blank)
Due to:  Severed subclavian vein
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence:  06 October 1948
Where did injury occur: On side of highway
While at work:  No
Means of injury:  Run over by truck
Signature & Address:  C. M. Aker, M.D., Lackey, Ky.
Date signed:  12 November 1948 
Transcribed by Debbie Tamborski, 29 December 2010