Date:   30 August 1941
Cert:   22642 
Place of Death: County: Knott Co.    City or Town: Lackey
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.
Full Name:  John CLARK
If Veteran Name War: (blank)
Social Security No.: 402-24-6625
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of:  (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased:  02 February 1923
Age: 18 years, 06 months, 28 days
Birthplace:  Garrett, Ky.
Occupation:  Labor
Industry or business: (blank)
Father Name:  Frank CLARK
Father Birthplace:  Johnson Co.
Mother Maiden Name:  Dallie TUSSEY
Mother Birthplace:  Greenup Co.
Informant:  Frank CLARK, Garrett, Ky.
Burial Place:  Garrett, Ky.
Date:  06 September 1941
Signature of funeral director: O. T. Lemaster, Martin, Ky.
Date received by local registrar:  20 September 1941
Registrar's Signature:  Phena Slone
Date of Death:  30 August 1941
I hereby certify that I attended deceased from 30 August 1941 to 30 August 1941, that I last saw him alive on 30 August 1941, and that death occurred on the date stated above at 11:30 p.m.
Immediate cause of death:  Crushing injuries of chest
Duration: 04 hours
Due to: Automobile injury
Other conditions:  traumatic shock
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: C. R. Messer, M.D., Lackey, Ky.
Date signed:  18 September 1941
Transcribed by Debbie Tamborski, 11 October 2010