Date: 19 January 1941
Cert: 17945
Place of Death: County: Knott City or
Town: Ritchie
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: Ritchie
Full Name: Robert Clyde BREEDING
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, yes, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 15 January 1941
Age: 04 days
Birthplace: Knott Co., Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: Venyard BREEDING
Father Birthplace: Hindman, Ky.
Mother Maiden Name: Laura COMBS
Mother Birthplace: Knott Co., Ky.
Informant: Laura COMBS, Ritchie, Ky.
Burial Place: Clear Creek
Date: 19 January 1941
Signature of funeral director: (blank)
Date received by local registrar: 31 July 1941
Registrar's Signature: Macie Miller
Date of Death: 19 January 1941
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 1:00 a.m.
Immediate cause of death: unknown
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: Elender Combs, Ritchie
Date signed: (blank)
Transcribed by Debbie Tamborski, 11 October 2010 |