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DEATH
CERTIFICATE
SAM COOK
Date: 26 November 1945
Cert: 26651
Place of Death: County: Lawrence City or Town:
Rural
Street No. or Location: Louisa, Ky., R. 2
Length of stay in hospital or community: 01 year
Usual Residence of Deceased: State: Ky. County:
Lawrence
City or Town: Clifford Rural
Full Name: Sam COOK
If Veteran Name War: (blank)
Social Security No.: 405-07-1209
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Sarah COOK
Age of husband or wife if alive: 50 years
Birth date of deceased: 22 July 1882
Age: 63 years, 04 months, 04 days
Birthplace: Knot Co., Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: John COOK
Father Birthplace: North Carolina
Mother Maiden Name: Winnie HARRISON
Mother Birthplace: North Carolina
Informant: Raymond COOK, Louisa, Ky., R. 2
Burial Place: Cook Cem.
Date: 28 November 1945
Signature of funeral director: Family
Date received by local registrar: 26 November 1945
Registrar's Signature: Elizabeth Wallace
Date of Death: 26 November 1945
I hereby certify that I attended deceased from April 1945 to
26 November 1945, that I last saw him alive on 10 November
1945, and that death
occurred on the date stated above at 2 p.m.
Immediate cause of death: Mitral insufficiency
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: (blank)
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: L. S. Hayes, M.D., Louisa, Ky.
Date signed: 13 December 1945
Transcribed by Debbie Tamborski, 05 June 2010 |
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