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DEATH
CERTIFICATE
EDWIN B. CLAGETT
Date 22 May 1940
Cert: 12874
Place of Death: County: Knott Co. City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Garrett, Ky., No. 19
Full Name: Edwin B. CLAGETT
If Veteran Name War: Spanish/American
Social Security No.: 406-03-2359
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Elsie CLAGETT
Age of husband or wife if alive: 54 years
Birth date of deceased: 22 June 1879
Age: 61 years, 10 months, 29 days
Birthplace: Washington, D.C.
Occupation: Miner
Industry or business: Elkhorn Coal Co.
Father Name: Henia Ki. CLAGETT
Father Birthplace: Maryland
Mother Maiden Name: Emma BOWENS
Mother Birthplace: Virginia
Informant/Address: Elsie CLAGETT, Garrett, Ky.
Burial Place: Garrett, Ky.
Date: 24 May 1940
Signature of funeral director/Address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 27 May 1940
Registrar's Signature: Macie Miller
Date of Death: 22 May 1940
I hereby certify that I attended deceased from 21 May 1940 to
22 May 1940, that I last saw him alive on 22 May 1940, and
that death occurred on the date stated above at 2:05 p.m.
Immediate cause of death: Cerebral Hemorrhage
Duration: (blank)
Due to: Hypertension
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: Edward D. Wells, Lackey, Ky.
Date signed: 28 May 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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