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DEATH
CERTIFICATE
GOMER CORNETTE
Date 19 October 1942
Cert: 21827
Place of Death: County: Floyd City or Town:
Martin
Name of Hospital: Beaver Valley Hospital
Length of stay in hospital or community: 07 days
Usual Residence of Deceased: State: Ky. County:
Pike
City or Town: Virgie
Full Name: Gomer CORNETTE
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: 10 November 1912
Age: 27 years, 11 months, 09 days
Birthplace: Knott Co.
Occupation: Miner
Industry or business: (blank)
Father Name: Riley CORNETTE
Father Birthplace: Don't know
Mother Maiden Name: Nannie FOUTS
Mother Birthplace: Don't know
Informant: Mrs. Abel TACKETT, Virgie, Ky.
Burial Place: Hartley, Ky.
Date: 24 October 1942
Signature of funeral director: G. D. Ryan, Martin, Ky.
Date received by local registrar: 31 October 1942
Registrar's Signature: Winifred Norris
Date of Death: 19 October 1942
I hereby certify that I attended deceased from 12 October 1942 to
19 October 1942, that I last saw him alive on 14 October 1942, and that death
occurred on the date stated above at 12:00 noon
Immediate cause of death: (blank)
Duration: (blank)
Due to: Lobar Pneumonia (bilateral)
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: Edward R. Cadden, M.D., Martin,
Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 25 May 2010 |
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