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DEATH
CERTIFICATE
ARNOLD GIBSON
Date 20 December 1940
Cert: 29237
Place of Death: County: Knott City or Town:
Bolen
Street number of Location: Rural
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Bolen
Full Name: Arnold GIBSON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Single
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: 27 October 1940
Age: 01 months, 22 days
Birthplace: Bolyn, Ky.
Occupation: none
Industry or business: (blank)
Father Name: Carew GIBSON
Father Birthplace: Bolen, Ky.
Mother Maiden Name: Marguerette GIBSON
Mother Birthplace: Bolen, Ky.
Informant/Address: Bill COLLINS
Burial Place: Bolyn, Ky.
Date: 21 December 1940
Signature of funeral director/address: J. S. GIBSON, Bolyn,
Ky.
Date received by local registrar: 29 December 1940
Registrar's Signature: Macie Miller
Date of Death: 20 December 1940
I hereby certify that I attended deceased from 16 December
1940 to (blank), that I last saw him alive on (blank), and
that death occurred on the date stated above at 1 a.m.
Immediate cause of death: Pneumonia
Duration: (blank)
Due to: (blank)
Major findings of operations: (blank)
Accident, suicide, or homicide: (blank)
Date of occurrence: 8:45 - 19 December 1940
Where did injury occur: (blank)
While at work: (blank)
Means of injury: (blank)
Signature & Address: T. J. Chandler, M.D., Lackey,
Ky.
Date signed: 21 December 1940
Transcribed by Debbie Tamborski, 17 August 2010 |
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