Date: 31 October 1941
Cert: 29451
Place of Death: County: Knott City or
Town: Rural
Street No. or Location: Cody, Ky.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Rural
Full Name: William CENTERS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Burnette CENTERS
Age of husband or wife if alive: 26 years
Birth date of deceased: 03 June
Age: 31 years
Birthplace: Powell Co., Ky.
Occupation: Coal Miner
Industry or business: (blank)
Father Name: Manuel CENTERS
Father Birthplace: Ky.
Mother Maiden Name: Gergewann Knox
Mother Birthplace: Ky.
Informant: Mrs. William CENTERS, Cody, Ky.
Burial Place: Carr Creek
Date: 02 November 1941
Signature of funeral director: Engle Und. & Hdwe., Hazard, Ky.
Date received by local registrar: 21 November 1941
Registrar's Signature: Anna L. Boulos
Date of Death: 31 October 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 (blank)
Immediate cause of death: Toxic Heart Failure
Duration: (blank)
Due to: Strep --sore throat toxin
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. R. Aker, M.D., Anco, Ky.
Date signed: 10 November 1941
Transcribed by Debbie Tamborski, 11 October 2010 |