Date: 15 March 1944
Cert: 07533
Place of Death: County: Knott City or
Town: Hindman, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: N.J.
County: Morris
City or Town: Rockway Township
Full Name: William M. BERRY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 17 September 1862
Age: 81 years, 05 months, 28 days
Birthplace: New Jersey
Occupation: Watch Tinker
Industry or business: (blank)
Father Name: Benjamin BERRY
Father Birthplace: N. J.
Mother Maiden Name: Mary J.
Mother Birthplace: N. J.
Informant: Mack STURGILL, Hindman
Burial Place: Holiday Cemetery
Date: 16 March 1944
Signature of funeral director: Mack Sturgill, Hindman
Date received by local registrar: 18 March 1944
Registrar's Signature: Ida Livingston
Date of Death: 15 March 1944
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw h-- alive on (illegible), and that death
occurred on the date stated above at (blank)
Immediate cause of death: T. B.
Duration: (blank)
Due to: (blank)
Other conditions: Senility
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: J. W. Duke, M.D., Hindman
Date signed: 17 March 1944
Transcribed by Debbie Tamborski, 07 November 2010 |