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DEATH
CERTIFICATE
SIMEON FRANCIS
Date 13 December 1940
Cert: 02302
Place of Death: County: Knott City or Town:
Carr Creek
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: Carr Creek
Full Name: Simeon FRANCIS
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Ida FRANCIS
Age of husband or wife if alive: 61 years
Birth date of deceased: 25 February 1873
Age: 67 years
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: Samuel FRANCIS
Father Birthplace: Knott
Mother Maiden Name: Lettie MULLINS
Mother Birthplace: Knott
Informant/Address: Vincent FRANCIS, Carr Creek, Ky.
Burial Place: Carr Creek
Date: 16 December 1940
Signature of funeral director/address: Nickoles, Hazard
Date received by local registrar: 23 January 1941
Registrar's Signature: Macie Miller
Date of Death: 13 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: paralysis
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: J. W. Duke, M.D., Hindman
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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