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DEATH
CERTIFICATE
JOHN M. GIBSON
Date 17 December 1940
Cert: 02303
Place of Death: County: Knott Co. City or Town:
Mousie, Ky.
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: Mousie
Full Name: John M. GIBSON
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Married
Husband or Wife of: Rebecca GIBSON
Age of husband or wife if alive: 68 years
Birth date of deceased: 07 December 1871
Age: 69 years, 10 days
Birthplace: Raven, Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Winston GIBSON
Father Birthplace: Wise, VA
Mother Maiden Name: Nancie HOLBROOKS
Mother Birthplace: Letcher Co.
Informant/Address: Martin GIBSON, Mousie
Burial Place: Mousie
Date: 20 December 1940
Signature of funeral director/address: W. J. Ryan, Martin, Ky.
Date received by local registrar: 09 January 1941
Registrar's Signature: Macie Miller
Date of Death: 17 December 1940
I hereby certify that I attended deceased from 13 December
1940 to
17 December 1940, that I last saw him alive on 13 December
1940, and that death
occurred on the date stated above at 3:30 a.m.
Immediate cause of death: Pneumonia (Bronchial)
Duration: 03 days
Due to: Cirrhosis of Liver
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: C. B. Ison, M.D., Garrett, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 17 August 2010 |
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