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DEATH
CERTIFICATE
HOBERT GAYHEART
Date 16 October 1940
Cert: 02298
Place of Death: County: Knott Co. City or Town:
Leburn
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: Leburn
Full Name: Hobert GAYHEART
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Pearl GAYHEART
Age of husband or wife if alive: 38 years
Birth date of deceased: 30 May 1907
Age: 33 years
Birthplace: Knott Co.
Occupation: Miner
Industry or business: (blank)
Father Name: John GAYHEART
Father Birthplace: Knott
Mother Maiden Name: Rachel SLONE
Mother Birthplace: Knott
Informant/Address: Mrs. John GAYHEART, Leburn, Ky.
Burial Place: Leburn
Date: 17 October 1940
Signature of funeral director/address: Family
Date received by local registrar: 23 January 1940
Registrar's Signature: Macie Miller
Date of Death: 16 October 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: Tuberculosis (Pulmonary)
Duration: years
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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