Date: 25 October 1941
Cert: 29462
Place of Death: County: Knott City or
Town: Lackey
Name of Hospital or Institution: Stumbo Memorial
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: W. Va.
County: Kanawah
City or Town: Charleston, W. Va.
Street No.: Kanawah St. #2020
Full Name: Tinnie WINN
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Female, Colored, Widow
Husband or Wife of: Al WINN
Age of husband or wife if alive: (blank)
Birth date of deceased: 25 December
Age: 65 years
Birthplace: W. Va.
Occupation: Maid
Industry or business: Housekeeping
Father Name: Si MANSI
Father Birthplace: Va.
Mother Maiden Name: Angie WOODS
Mother Birthplace: Va.
Informant: George FORD, Weeksberry, Ky.
Burial Place: Weeksberry, Ky.
Date: 28 October 1941
Signature of funeral director: J. L. Malone, Bypro, Ky.
Date received by local registrar: (blank)
Registrar's Signature: (blank)
Date of Death: 25 October 1941
I hereby certify that I attended deceased from 15 October 1941 to
25 October 1941, that I last saw her alive on 25 October 1941, and that death
occurred on the date stated above at 10 p.m.
Immediate cause of death: Pneumonia
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: W. L. Stumbo, M.D., Lackey, Ky.
Date signed: 01 November 1941
Transcribed by Debbie Tamborski, 15 October 2010 |