|
DEATH
CERTIFICATE
RALPH S. COOK
Date 10 August 1933
Cert: 19885
Place of Death: Voting Pct. #1, M. E. Hospital,
Pikeville, Pike Co., Ky.
Full Name: Ralph S. COOK
Residence: Halo
Length of Residence: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: (blank)
Date of Birth: 23 June 1909
Age: 24 years, 01 months, 10 days
Occupation: Teacher
Birthplace: Knott Co.
Father Name: Seland COOK
Birthplace Father: Knott Co.
Mother Maiden Name: Liza COOK
Birthplace Mother: Knott Co.
Informant/Address: Liza COOK
Burial Cremation Removal Place: Removal - Halo, Ky.
Date: 10 August 1933
Undertaker/Address: G. D. Ryan, Martin, Ky.
Filed: 15 August 1933
Registrar: J. C. Wright
Death of Date: 10 August 1933
I hereby certify, That I attended deceased from 08 August 1933 to
10 August 1933, that I last saw him alive on 10 August 1933, death is said
to have occurred on the date stated above, at 5:45 p.m.
Cause of Death: Gun Shot wound & fracture at base
(?spine?--illegible)
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: A. G. Osborne, M.D., Pikeville, Ky.
Transcribed by Debbie Tamborski, 01 April 2010 |
|