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DEATH
CERTIFICATE
JOHNNIE CORNETT
Date 23 August 1940
Cert: 21957
Place of Death: County: Knott City or Town:
Sassafras
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Sassafras
Full Name: Johnnie CORNETT
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 27 April 1933
Age: 07 years, 03 months, 27 days
Birthplace: Sassafras
Occupation: School boy
Industry or business: (blank)
Father Name: John CORNETT
Father Birthplace: Sassafras
Mother Maiden Name: Catherine SMITH
Mother Birthplace: Clear Creek
Informant/Address: Belle CORNETT MILLER, Cody, Ky.
Burial Place: Cornett Hill
Date: 24 August 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 13 September 1940
Registrar's Signature: Macie Miller
Date of Death: 23 August 1940
I hereby certify that I attended deceased from (blank) to
(blank), that I last saw him alive on (blank), and that death
occurred on the date stated above at (blank)
Immediate cause of death: Broncho Pneumonia
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: J. W. Duke, M.D., Hindman
Date signed: 13 September 1940
Transcribed by Debbie Tamborski, 17 August 2010 |
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