Date:   31 December 1941
Cert:   29453 
Place of Death: County: Knott     City or Town: Mousie rural
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:  Mousie
Full Name:  Harry CHAFFINS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Divorced
Husband or Wife of:  Sue (illegible)
Age of husband or wife if alive:  (blank)
Birth date of deceased:  (blank)
Age: 49 years
Birthplace:  Knott Co.
Occupation:  Miner
Industry or business: Mining
Father Name:  Jasper CHAFFINS
Father Birthplace:  Knott
Mother Maiden Name:  Jude HUNTER
Mother Birthplace:  Knott Co.
Informant:  Zeer CHAFFINS, Mantie, Ky.
Burial Place:  Rock Fork Boleyn 
Date:  02 January 1941
Signature of funeral director: Ryan F. (illegible), Martin, Ky.
Date received by local registrar:  03 January 1942
Registrar's Signature:  Ida Livingston
Date of Death:  31 December 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:  Pneumonia Tuberculosis
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:  03 January 1942
Transcribed by Debbie Tamborski, 11 October 2010