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DEATH
CERTIFICATE
SHELBY CLARKE
Date 08 May 1934
Cert: 13927
Place of Death: Voting Pct.: 41 N. Martin, Beaver Valley
Hospital, Floyd Co., Ky.
Full Name: Shelby CLARKE
Residence: Hindman, Ky.
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Date of Birth: 01 August 1908
Age: 26 years, 09 months, 08 days
Occupation: Drugest, Own Store
Birthplace: Knott Co., Ky.
Father Name: George CLARKE
Birthplace Father: Greenup Co., Ky.
Mother Maiden Name: Lucinda HAYS
Birthplace Mother: Knott Co., Ky.
Informant/Address: George CLARKE, Hindman, Ky.
Burial Cremation Removal Place: Hindman, Ky.
Date: 10 May 1934
Undertaker/Address: Preston Ray, Jaspoon, Ky.
Filed: 09 May 1934
Registrar: Mrs. W. L. Stumbo
Death of Date: 08 May 1934
I hereby certify, That I attended deceased from 07 May 1934 to
08 May 1934, that I last saw him alive on 07 May 1934, death
is said to have occurred on the date stated above, at 4:15
p.m.
Cause of Death: Gun shot wound
Date of onset: (blank)
Contributory causes: (blank)
Name of operation: (blank)
Accident, suicide, homicide: (blank)
Date of Injury: (blank)
Where did injury occur: (blank)
Specify whether injury occurred industry, home, public place:
Manner of injury: (blank)
Nature of injury: (blank)
Related to occupation: (blank)
Signed/Address: W. L. Stumbo, Martin, Ky.
Transcribed by Debbie Tamborski, 05 April 2010 |
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