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DEATH
CERTIFICATE
SILDA SMITH
Date 29 April 1940
Cert: 20203
Place of Death: County: Perry City or
Town: (blank)
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community: 1 day
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Anco, Ky.
Full Name: Silda SMITH
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Andrew
Age of husband or wife if alive: 30 years
Birth date of deceased: 23 November 1911
Age: 29 years
Birthplace: Knott Co., Ky.
Occupation: Hswf.
Industry or business: (blank)
Father Name: Thos. BEVERLY
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: ?
Mother Birthplace: Cal.
Informant: Andrew SMITH, Anco, Ky.
Burial Place: Yellow Creek
Date: 01 May 1940
Signature of funeral director: Engle
(illegible) & Hdwe., Hazard, Ky.
Date received by local registrar: 19 August 1940
Registrar's Signature: Kathryn S. Johnson
Date of Death: 29 April 1940
I hereby certify that I attended deceased from 27 April 1940
to 29 April 1940, that I last saw her alive on 29 April 1940,
and that death occurred on the date stated above at 6:30
p.m.
Immediate cause of death: Prolapse uteri
Due to: No childbirth
Major findings of operations: (illegible)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature: J. E. Hazan, M.D., Hazard, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 31 January 2010 |
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