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DEATH
CERTIFICATE
WILLIAM N. BLAIR
Date 05 December 1940
Cert: 10602
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: Kentucky County:
Letcher
City or Town: Letcher Co.
Full Name: William N. BLAIR
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: Sally BANKS
Age of husband or wife if alive: (blank)
Birth date of deceased: 03 January 183
Age: 68 years, 11 months
Birthplace: Jeremiah, Ky.
Occupation: Farming
Industry or business: (blank)
Father Name: Preston H. BLAIR
Father Birthplace: Whitesburg, Ky.
Mother Maiden Name: unknown
Mother Birthplace: (blank)
Informant/Address: Harrison BLAIR, Cody, Ky.
Burial Place: Jeremiah, Ky.
Date: 06 December 1940
Signature of funeral director/Address: (blank)
Date received by local registrar: 22 April 1941
Registrar's Signature: Macie Miller
Date of Death: 05 December 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: paralysis
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: J. W. Duke, M.D., Hindman
Date signed: (blank)
Transcribed by Debbie Tamborski, 16 August 2010 |
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