Date:   17 November 1941
Cert:   29466 
Place of Death: County: Knott     City or Town: Rural
Street No. or Location:  Carr Creek
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.      County: Knott
City or Town:  Rural
Full Name:  Cassie STACY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Married
Husband or Wife of:  S. M. STACY
Age of husband or wife if alive:  75 years
Birth date of deceased:  (blank)
Age: 76 years
Birthplace:  Knott Co.
Occupation:  House wf.
Industry or business: (blank)
Father Name:  Samuell FRANCES
Father Birthplace:  Knott Co.
Mother Maiden Name:  Lettie MULLINS
Mother Birthplace:  Knott Co.
Informant:  H. G. BLAIR, Carr Creek
Burial Place:  Carr Creek
Date:  18 November 1941
Signature of funeral director: Engle Und. & Hdwe., Hazard, Ky.
Date received by local registrar:  (blank)
Registrar's Signature:  (blank)
Date of Death:  17 November 1941
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:  This woman died suddenly without medical attention
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: (blank)
Date signed:  (blank)
Transcribed by Debbie Tamborski, 15 October 2010