|
DEATH
CERTIFICATE
POLLY VAUGHAN
Date 03 March 1937
Cert: Duplicate # 24072
Original #8269
Place of Death: Voting Pct.: Riceville, Johnson Co., Ky.
Full Name: Polly VAUGHAN
Residence: (blank)
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Female, White,
Married
Husband or Wife of: Walter Nolan VAUGHAN
Date of Birth: (blank)
Age: 25 years, 05 months, 10 days
Occupation: House keeper
Birthplace: Knot Co., Ky.
Father Name: Dile FUGGATE
Birthplace Father: Carrie, Ky.
Mother Maiden Name: Elizebeth JOHNSON
Birthplace Mother: Ky.
Informant/Address: Walter VAUGHAN, Riceville, Ky.
Burial Cremation Removal Place: (illegible) Cem.
Date: 04 March 1937
Undertaker/Address: Paintsville Furn. Co., Paintsville,
Ky.
Filed: 06 July 1937
Registrar: Mrs. Walter Vaughan
Death of Date: 03 March 1937
I hereby certify, That I attended deceased from 10 February
1937 to 03 March 1937, that I last saw her alive on 03 March
1937, death is said to have occurred on the date stated above,
at 11 a.m.
Cause of Death: Blood stream infection from
appendicitis operation
Date of onset: 02 May 1934
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: W. R. Castle, M.D., Paintsville, Ky.
Transcribed by Debbie Tamborski, 22 April 2010 |
|