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DEATH
CERTIFICATE
JIMMIE RAY DYER
Date 14 October 1940
Cert: 29242
Place of Death: County: Knott City or Town:
Hindman
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: Hindman
Full Name: Jimmie Ray DYER
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: 06 October 1940
Age: 08 days
Birthplace: Knott Co.
Occupation: (blank)
Industry or business: (blank)
Father Name: Willard DYER
Father Birthplace: Knott Co.
Mother Maiden Name: Cora COLLINS
Mother Birthplace: Knott Co.
Informant/Address: Willard DYER, Hindman
Burial Place: Hindman
Date: 15 October 1940
Signature of funeral director/address: Family
Date received by local registrar: 23 December 1940
Registrar's Signature: Macie Miller
Date of Death: 14 October 1940
I hereby certify that I attended deceased from 06 October 1940 to
14 October 1940, that I last saw him alive on 14 October 1940, and that death
occurred on the date stated above at 4 p.m.
Immediate cause of death: Pneumonia
Duration: (blank)
Due to: Don't Know
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: M. F. Kelley, Hindman, Ky.
Date signed: 23 December 1940
Transcribed by Debbie Tamborski, 17 August 2010 |
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