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DEATH
CERTIFICATE
GEORGE CLARKE
Date 25 December 1940
Cert: 29243
Place of Death: County: Knott City or Town:
Hindman
Street Number or Location: Residence
Length of stay in hospital or community: 04 months
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Hindman, Ky.
Full Name: George CLARKE
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, (illegible)
Husband or Wife of: (illegible)
Age of husband or wife if alive: 66 years
Birth date of deceased: 23 December 1862
Age: 78 years, 02 days
Birthplace: Greenup Co., Ky.
Occupation: Teacher
Industry or business: Teaching
Father Name: Anthony G. CLARKE
Father Birthplace: State of Va.
Mother Maiden Name: Martha CALLAHAN
Mother Birthplace: Greenup Co., Ky.
Informant/Address: Lucinda CLARKE, Hindman, Ky.
Burial Place: Days Cemetery
Date: 29 December 1940
Signature of funeral director/address: Ray & Blake, Jackson,
Ky.
Date received by local registrar: 29 December 1940
Registrar's Signature: Macie Miller
Date of Death: 25 December 1940
I hereby certify that I attended deceased from (illegible) to
(illegible) 1940, that I last saw him alive on 25 December,
and that death occurred on the date stated above at 5 p.m.
Immediate cause of death: appoplexia
Duration: (blank)
Due to: None
Major findings of operations: None Of
Autopsy: None
Accident, suicide, or homicide: no
Date of occurrence: no
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: M. F. Kelley, Hindman, Ky.
Date signed: 29 December 1940
Transcribed by Debbie Tamborski, 16 August 2010 |
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