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DEATH
CERTIFICATE
ALA STACY
Date 07 November 1917
Cert: 29532
Place of Death: Voting Precinct: Springfork, Breathitt
Co., Ky.
Full Name: Ala STACY
Sex, Color or Race, Marital Status: Female, White,
(blank)
Date of Birth: 04 November 1917
Age: (blank)
Occupation: (blank)
Birthplace: Knott Co., Ky.
Name of Father: Simon STACY
Birthplace Father: Knott Co.
Maiden name of Mother: Bethana RUSSELL
Birthplace Mother: (blank)
Informant/Address: Keney Carpenter, Guage, Ky.
Filed: 07 November 1917
Registrar: A. D. C.
Death Date: 07 November 1917
I hereby certify that I attended deceased from (blank), to
(blank), that I last saw h-- alive on (blank), and that death
occurred, on the date stated above, at (blank)
Cause of Death: (illegible) of mother
Duration: (blank)
Contributory: (blank)
Signed/Address: (blank)
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Billie Russell Cem.
Date of Burial: 08 November 1917
Undertaker/Address: Simon Stacy, Lambric
Transcribed by Debbie Tamborski, 28 February 2010 |
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