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DEATH
CERTIFICATE
HARLAN FRANCIS
Date 21 August 1941
Cert: 20445
Place of Death: County: Letcher City or Town:
Blackey
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Letcher
City or Town: Blackey
Full Name: Harlan FRANCIS
If Veteran Name War: (blank)
Social Security No.: 403-18-6016
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Stella FRANCIS
Age of husband or wife if alive: 32 years
Birth date of deceased: 01 October 1879
Age: 61 years, 10 months, 20 days
Birthplace: Knott Co., Ky.
Occupation: Carpenter
Industry or business: (blank)
Father Name: Kelly FRANCIS
Father Birthplace: Ky.
Mother Maiden Name: Nancy PIGMAN
Mother Birthplace: Ky.
Informant: Stella FRANCIS (wife), Letcher, Ky.
Burial Place: Carr Creek, Ky.
Date: 22 August 1941
Signature of funeral director: Family, Blackey, Ky.
Date received by local registrar: 25 August 1941
Registrar's Signature: E. M. Collins
Date of Death: 21 August 1941
I hereby certify that I attended deceased from (blank) to
time to time, that I last saw him alive on (blank), and that
death occurred on the date stated above at 7:15 a.m.
Immediate cause of death: Tertiary syphilis
Duration: 02 years
Due to: Had much antileutic therapy
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: R. D. Collins, M.D., Whitesburg,
Ky.
Date signed: 24 August 1941
Transcribed by Debbie Tamborski, 13 May 2010 |
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