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DEATH
CERTIFICATE
SUSAN TERRY
Date 31 December 1942
Cert: 03363
Place of Death: County: Floyd City or Town:
Lackey
Street No. or Location: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Lackey
Full Name: Susan TERRY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 07 March 1861
Age: 81 years, 09 months, 24 days
Birthplace: Knott Co., Ky.
Occupation: Domestic
Industry or business: (blank)
Father Name: Hiram BEVERLY
Father Birthplace: Wise, Va.
Mother Maiden Name: Rosanna SLOAN
Mother Birthplace: Knott Co., Ky.
Informant: Rhoda GIBSON, Raven, Ky.
Burial Place: Wayland, Ky.
Date: 03 January 1943
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 05 January 1943
Registrar's Signature: Winifred Norris
Date of Death: 31 December 1942
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw her alive on 31 December 1942, and
that death occurred on the date stated above at 11:30 p.m.
Immediate cause of death: Lobar pneumonia
Duration: (blank)
Due to: Influenza
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: M. V. Wicker, M.D., Wayland,
Ky.
Date signed: 05 January 1943
Transcribed by Debbie Tamborski, 30 May 2010 |
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