Date: 09 January 1948
Cert: 01370
Place of Death: County: Knott City or
Town: Carrie
Name of Hospital or Institution: none
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky.
County: Knott
City or Town: Carrie
Full Name: Ray EVERAGE
If Veteran Name War: None
Social Security No.: None
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: ?? (transcribed as
written)
Age: 24 years
Birthplace: Tina, Ky.
Occupation: None
Industry or business: None
Father Name: B. W. EVERAGE
Father Birthplace: Hindman, Ky.
Mother Maiden Name: Maggie PERKINS
Mother Birthplace: Knott County, Ky.
Informant: B. W. EVERAGE, Hindman, Ky.
Burial Place: Tina, Ky.
Date: 11 January 1948
Signature funeral director: Maggard-Blair & Garrett,
Hazard, Ky.
Date received by local registrar: 13 January 1948
Registrar's Signature: Rose B. Craft
Date of Death: 09 January 1948
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 6 a.m.
Immediate cause of death: (blank)
Duration: (blank)
Due to: Pulmonary T. B.
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 January 1948
Transcribed by Debbie Tamborski, 24 December 2010 |