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DEATH
CERTIFICATE
JOHINE DAVIS
Date 01 November 1931
Cert: 13488
Place of Death: Voting Pct: Beaver Valley Hosp., John Possum,
Martin, Floyd Co., Ky.
Full Name: Johine DAVIS
Residence: Jacks Creek
Length of Residence in city where death occurred:
(blank)
Sex, Color or Race, Marital Status: Male, White, Blank
Husband or Wife of: Johine DAVIS
Date of Birth: 30 November 1911
Age: 21 years, 11 months, 28 days
Occupation: Miner
Birthplace: Knott
Father Name: Tomie DAVIS
Birthplace Father: Va.
Mother Maiden Name: Rhoda LITTLE
Birthplace Mother: Floyd
Informant/Address: D. R. DAVIS, Halo, Ky.
Filed: 17 November 1931
Registrar: Mrs. W. L. Stumbo per Anna Reynolds
Death of Date: 01 November 1931
I hereby certify that I attended deceased from 31 October 1931 to
01 November 1931, that I last saw him alive on 7:10 p.m. 1931, and that death
occurred on the date stated above at (blank)
Cause of Death: Shot through abdomen
Duration: 01 day
Contributory: Shot
Duration: (blank)
Where was disease contracted if not at place of death?:
(blank)
Did an operation precede death: Yes Date: 01 November
1931
Was there an autopsy: (blank)
What test confirmed diagnosis: (blank)
Signed/Address: W. L. Stumbo, M.D., (illegible), Martin,
Ky.
Place of Burial or Removal: Jacks Creek, Ky.
Date of Burial: 02 November 1931
Undertaker/Address: Family, Jacks Creek, Ky.
Transcribed by Debbie Tamborski, 30 March 2010 |
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