Date: 10 October 1944
Cert: 13038
Place of Death: County: Knott City or
Town: Hollybush
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Hollybush
Full Name: Wilburn TRIPLETT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Lonie CONLEY
Age of husband or wife if alive: 37 years
Birth date of deceased: 10 September 1904
Age: 40 years, 01 months, 00 days
Birthplace: Hollybush, Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: William TRIPLETT
Father Birthplace: Hollybush, Ky.
Mother Maiden Name: Cordelia SLONE
Mother Birthplace: Knott Co., Ky.
Informant: Jasper CAUDILL, Hollybush, Ky.
Burial Place: Hollybush, Ky.
Date: 12 October 1944
Signature of funeral director: Friends & family,
Hollybush, Ky.
Date received by local registrar: 21 March 1945
Registrar's Signature: Rose B. Craft
Acting Registrar Per B. Carns
Date of Death: 10 October 1944
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: Epileptic and fell in the
creek and drowned while under the fit
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: M. F. Kelley, M.D., Hindman,
Ky.
Date signed: 28 March 1945
Transcribed by Debbie Tamborski, 26 November 2010 |