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DEATH
CERTIFICATE
WILLIE GIBSON
Date 02 October 1940
Cert: 25875
Place of Death: County: Hardin City or Town: Fort
Knox, Ky.
Name of Hospital or Institution: (blank)
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County: (blank)
City or Town: (blank)
Full Name: Willie 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: 04 December 1915
Age: 24 years, 09 months, 28 days
Birthplace: Red Fox, Ky.
Occupation: Farmer
Industry or business: (blank)
Father Name: Kendrick GIBSON
Father Birthplace: Unknown
Mother Maiden Name: Unknown
Mother Birthplace: Unknown
Informant: Service Record, U.S. Army
Burial Place: Shipped to Hazard, Ky.
Date: 03 October 1940
Signature of funeral director: W. G. Hardy, Jr., West Point,
Ky.
Date received by local registrar: 16 November 1940
Registrar's Signature: Mrs. Ethel Y. McClure
Date of Death: 02 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: Compound fracture of skull
Duration: (blank)
Due to: (illegible) accident
Major findings of autopsy: Same as above diagnosis
Accident, suicide, or homicide: (blank)
Date of occurrence: 02 October 1940
Where did injury occur: Government reservation
While at work: (blank)
Means of injury: (blank)
Signature & Address: Richard D. Martin, M.D.,
Station Hospital, Fort Knox, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 09 May 2010 |
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