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DEATH
CERTIFICATE
BALIS GAYHEART
Date 27 May 1940
Cert: 15192
Place of Death: County: Knott Co. City or Town:
Lackey, Ky.
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Fisty, Ky.
Full Name: Balis GAYHEART
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Rachell GAYHEART
Age of husband or wife if alive: 55 years
Birth date of deceased: 05 January 1889
Age: 61 years, 05 months, 22 days
Birthplace: Perry Co.
Occupation: Labor
Industry or business: State Highway
Father Name: Alexander GAYHEART
Father Birthplace: Perry Co.
Mother Maiden Name: Milsla ENGLE
Mother Birthplace: Perry Co.
Informant/Address: Chester GAYHEART, Dwarf, Ky.
Burial Place: Fisty
Date: 28 May 1940
Signature of funeral director/address: (blank)
Date received by local registrar: 20 June 1940
Registrar's Signature: Macie Miller
Date of Death: 27 May 1940
I hereby certify that I attended deceased from 27 May 1940 to
27 May 1940, that I last saw him alive on 27 May 1940, and that death
occurred on the date stated above at 5:30 p.m.
Immediate cause of death: Injury to head
Duration: (blank)
Due to: Hit by Auto
Major findings of operations: (blank)
Accident, suicide, or homicide: Accident
Date of occurrence: 27 May
Where did injury occur: Public Highway
While at work: Yes
Means of injury: Fractured skull
Signature & Address: Edward Wells, M.D., Lackey, Ky.
Date signed: 27 May 1940
Transcribed by Debbie Tamborski, 17 August 2010 |
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