|
DEATH
CERTIFICATE
HARLAN COLLINS
Date 12 June 1919
Cert: 28152
Place of Death: Voting Precinct: West Ward, Whitesburg,
Letcher Co., Ky.
Full Name: Harlan COLLINS
Sex, Color or Race, Marital Status: Male, White, Single
Date of Birth: 18 January 1891
Age: 28 years, 04 months, 24 days
Occupation: U. S. Soldier
Birthplace: Knott County, Ky.
Name of Father: John D. COLLINS
Birthplace Father: Letcher County, Ky.
Maiden name of Mother: Sallie STACY
Birthplace Mother: Letcher Co., Ky.
Informant/Address: John D. X his mark
COLLINS, Whitesburg, Ky.
Filed: 13 November 1919
Registrar: S. L. Blair
Death Date: 12 June 1919
I hereby certify that I attended deceased from 11 June 1919, to
11 June 1919, that I last saw him alive on 11 June 1919, and
that death occurred, on the date stated above, at 7 a.m.
Cause of Death: Gunshot wound of abdomen inflicted by
unknown person
Duration: 02 days
Contributory: Gunshot
Signed/Address: Bert C. Back, M.D., 12 June
1919, Whitesburg, Ky.
Length of residence where disease contracted: (blank)
Former or usual residence: (blank)
Place of Burial or Removal: Sandlick Cemetery
Date of Burial: 12 June 1919
Undertaker/Address: Family
Transcribed by Debbie Tamborski, 05 March 2010 |
|