DEATH
CERTIFICATE
WAYNE BLAIR
Date 14 November 1940
Cert: 26572
Place of Death: County: Knott City or Town:
Cody
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: Cody
Full Name: Wayne BLAIR
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: 13 November 1940
Age: 12 hours
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: William McKinley BLAIR
Father Birthplace: Knott Co.
Mother Maiden Name: Ezzie FEANCE
Mother Birthplace: Knott
Informant/Address: William McKinley BLAIR, Cody
Burial Place: Cody
Date: 15 November 1940
Signature of funeral director/Address: Family
Date received by local registrar: 18 November 1940
Registrar's Signature: Macie Miller
Date of Death: 14 November 1940
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: premature birth
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: Mary Morton, Cody
Date signed: 14 November 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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