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DEATH
CERTIFICATE
EDWARD COOK
Date 22 November 1939
Cert: 27065
Place of Death: County: Floyd Co. City or Town: Wayland,
Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Kentucky
County: Floyd
City or Town: Wayland, Ky.
Full Name: Edward COOK
If Veteran Name War: (blank)
Social Security No.: 400-07-6228
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Essie COOK
Age of husband or wife if alive: 22 years
Birth date of deceased: 08 November 1915
Age: 24 years, 14 days
Birthplace: Knott Co.
Occupation: Miner
Industry or business: (blank)
Father Name: Albert L. COOK
Father Birthplace: Knott Co.
Mother Maiden Name: Cora OSBURNE
Mother Birthplace: Floyd Co.
Informant: Essie COOK, Wayland, Ky.
Burial Place: Topmost, Ky.
Date: 23 November 1939
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 23 November 1939
Registrar's Signature: Mrs. Ben Norris
Date of Death: 22 November 1939
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on 22 November 1939, and
that death occurred on the date stated above at 6:00 p.m.
Immediate cause of death: Killed instantly by mine motor
Duration: (blank)
Due to: Crushed Face and Fractured Skull
Major findings of autopsy: no
Accident, suicide, or homicide: Accident
Date of occurrence: 22 November
Where did injury occur: Industrial mines
While at work: yes
Means of injury: Motor
Signature & Address: G. D. Ryan, M.D., Martin, Ky.
Date signed: 22 November
Transcribed by Debbie Tamborski, 03 May 2010 |
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