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DEATH
CERTIFICATE
BELVIA WILLIAMS
Date 29 January 1921
Cert: 06160
Place of Death: Voting Precinct: #5, Blackey, Letcher
Co., Ky.
Full Name: Belvia WILLIAMS
Sex, Color or Race, Marital Status: Female, Negro,
Married
Date of Birth: age 21 years
Age: 21 years
Occupation: Housework
Birthplace: Knott Co., Ky.
Name of Father: Thomas HIGGIN
Birthplace Father: Ky.
Maiden name of Mother: (blank)
Birthplace Mother: Ky.
Informant/Address: McKinley WILLIAMS, Redfox, Ky.
Filed: 07 February 1921
Registrar: R. B. Caudill
Death Date: 29 January 1921
I hereby certify that I attended deceased from 24 January 1921, to
29 January 1921, that I last saw her alive on 29 January 1921, and that death
occurred, on the date stated above, at (blank)
Cause of Death: Pneumonia Fever
Duration: 06 days
Contributory: (blank)
Signed/Address: Dr. G. D. Ison, M.D., 07
February 1921, Blackey, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 07 March 2010 |
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