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DEATH
CERTIFICATE
RACHAEL STEPHENS
Date 29 September 1939
Cert: 29632
Place of Death: County: Floyd City or
Town: Sloan
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Floyd
City or Town: James Banks
Full Name: Rachael STEPHENS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Sam STEPHENS
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 January 1878
Age: 61 years, 08 months, 14 days
Birthplace: Knott Co.
Occupation: housewife
Industry or business: (blank)
Father Name: Jake BRADLEY
Father Birthplace: Kentucky
Mother Maiden Name: Barbara HALE
Mother Birthplace: Kentucky
Informant: Emma COYER, Slone, Ky.
Burial Place: Slone, Ky.
Date: 30 September 1939
Signature of funeral director: none
Date received by local registrar: 15 December 1939
Registrar's Signature: Mrs. Ben Norris
Date of Death: 29 September 1939
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: Pulmonary Tuberculosis
Duration: 02 years
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: Marvin Ramsdell, MD, Prestonsburg, Ky.
Date signed: 16 December 1939
Transcribed by Debbie Tamborski, 05 May 2010 |
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