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DEATH
CERTIFICATE
KATIE TAYLOR
Date 31 October 1930
Cert: 28495
Place of Death: Voting Pct. #15 Kodak, Perry Co., Ky.
Full Name: Katie TAYLOR
Residence: (blank)
Sex, Color or Race, Marital Status Female, Colored,
Single
Husband or Wife of: (blank)
Date of Birth: (blank)
Age: 01 years, 04 months
Occupation: at home
Birthplace: Knott Co., Ky.
Father Name: Frank TAYLOR
Birthplace Father: Ky.
Mother Maiden Name: Kathryn TAYLOR
Birthplace Mother: Ky.
Informant/Address: T. B. BROWN, Kodak, Ky.
Burial Cremation Removal Place: Burial, Kodak, Ky.
Date: 01 November 1930
Undertaker/Address: (blank)
Filed: 04 December 1930
Registrar: Bud Morgan
Death of Date: 31 October 1930
I hereby certify, That I attended deceased from 01 October
1930 to 31 October 1930, that I last saw her alive on 31
October 1930, death is said to have occurred on the date
stated above, at 3 p.m.
Cause of Death: Rachitis
Date of onset: (blank)
Contributory causes: undernourished
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Specify where injury occurred: (blank)
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: No
Signed/Address: H. Hensley, M.D., Kodak, Ky.
Transcribed by Debbie Tamborski, 29 March 2010 |
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