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DEATH
CERTIFICATE
WILLARD FITZPATRICK
Date 13 May 1942
Cert: 12347
Place of Death: County: Perry City or Town:
Rural
Street No. or Location: Hardburley, Ky.
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Perry
City or Town: Rural If
rural/precinct: Ary, Ky.
Full Name: Willard FITZPATRICK
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widowed
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 09 April 1897
Age: 45 years, 01 months, 04 days
Birthplace: Knott Co., Ky.
Occupation: Coal Miner
Industry or business: (blank)
Father Name: Alex FITZPATRICK
Father Birthplace: Knott Co., Ky.
Mother Maiden Name: Lucendie GRIFFITH
Mother Birthplace: Ky.
Informant: E. B. FUGATE, Ary, Ky.
Burial Place: Ary, Ky.
Date: 15 May 1942
Signature of funeral director: Engle Und. & Hdwe., Hazard, Ky.
Date received by local registrar: 30 May 1942
Registrar's Signature: A. L. Boulos
Date of Death: 13 May 1942
I hereby certify that I attended deceased on 13 May 1942 Post
Mortem, that I last saw him alive on (blank), and that death
occurred on the date stated above at 10:30 a.m.
Immediate cause of death: Accidental injury
Duration: (blank)
Due to: Slate Fall in mine
Major findings of operations: (blank)
Accident, suicide, or homicide: accident
Date of occurrence: 13 May 1942
Where did injury occur: Industry - coal mine
While at work: Yes
Means of injury: Slate Fall
Signature & Address: H. W. Gingles, M.D., Hardburly,
Ky.
Date signed: 22 May 1942
Transcribed by Debbie Tamborski, 25 May 2010 |
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