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DEATH
CERTIFICATE
BANNER FITCHPATRICK
Date 20 December 1940
Cert: 29239
Place of Death: County: Knott City or Town:
Handshoe (Rural)
Name of Hospital or Institution: none
Length of stay in hospital or community: 03 days
Usual Residence of Deceased: State: Kentucky County:
Knott
City or Town: Handshoe (Rural)
Full Name: Banner FITCHPATRICK
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: none
Age of husband or wife if alive: (blank)
Birth date of deceased: 08 June 1940
Age: 06 months, 12 days
Birthplace: Handshoe, Ky.
Occupation: none
Industry or business: none
Father Name: Okie FITCHPATRICK
Father Birthplace: Elmrock, Ky.
Mother Maiden Name: Elsie COLLINS
Mother Birthplace: Handshoe, Ky.
Informant/Address: Elsie FITCHPATRICK,
Yellow Mountain, Ky.
Burial Place: Yellow Mt.
Date: 21 December 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 30 December 1940
Registrar's Signature: Macie Miller
Date of Death: 20 December 1940
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: Whooping Cough
Duration: (blank)
Due to: (blank)
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: Alafair Cox, Yellow Mt.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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