Date: 07 September 1942
Cert: 27682
Place of Death: County: Knott City or
Town: Vest, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: (blank)
County: (blank)
City or Town: (blank)
Full Name: Adam DOBSON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: (blank)
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 26 October 1917
Age: 24 years
Birthplace: Vest, Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Wm. DOBSON
Father Birthplace: Knott Co.
Mother Maiden Name: Florida RITCHIE
Mother Birthplace: Knott Co.
Informant: Florida DOBSON, Hindman, Ky.
Burial Place: Vest
Date: 09 September 1942
Signature of funeral director: Siles Terry, Vest, Ky.
Date received by local registrar: 10 December 1943
Registrar's Signature: (blank)
Date of Death: 07 September 1942
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: (illegible) suicide by gun shot
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: Suicide
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, Ky.
Date signed: 16 December 1943
Transcribed by Debbie Tamborski, 23 October 2010 |