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DEATH
CERTIFICATE
MARTHA GIBSON STALEY
Date 07 July 1921
Cert: 14604
Place of Death: Voting Precinct: Allen, Beaver, Floyd
Co., Ky.
Full Name: Martha GIBSON STALEY
Sex, Color or Race, Marital Status: Female, White,
Married
Date of Birth: 1875
Age: 46 years
Occupation: Housekeeper
Birthplace: Knott Co., Ky.
Name of Father: (blank)
Birthplace Father: (blank)
Maiden name of Mother: (blank)
Birthplace Mother: (blank)
Informant/Address: John STALEY, Allen, Ky.
Filed: 30 July 1921
Registrar: Theop. Salmons
Death Date: 07 July 1921
I hereby certify that I attended deceased from June 1921, to
July 1921, that I last saw her alive on 07 July 1921, and that
death occurred, on the date stated above, at p.m.
Cause of Death: Typhoid Fever
Duration: 21 days
Contributory: (blank)
Signed/Address: Dr. H. H. Mays, M.D., 30
July 1921, Smalley, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: on Caney Creek
Date of Burial: 09 July 1921
Undertaker/Address: (blank), Knott Co., Ky.
Transcribed by Debbie Tamborski, 07 March 2010 |
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