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DEATH
CERTIFICATE
ELIJAH GRIGSBY
Date 09 November 1942
Cert: 27828
Place of Death: County: Perry City or Town:
Hazard
Name of Hospital or Institution: Hazard Hospital Co.
Length of stay in hospital or community:
Usual Residence of Deceased: State: Ky. County:
Knott
City or Town: Vest Rural
Full Name: Elijah GRIGSBY
If Veteran Name War: (blank)
Social Security No.: (blank)
Sex, Color or Race, Marital Status: Male, White, Widower
Husband or Wife of: (blank)
Age of husband or wife if alive: (blank)
Birth date of deceased: (blank)
Age: 76 years
Birthplace: Knott Co.
Occupation: Farmer
Industry or business: (blank)
Father Name: John L. GRIGSBY
Father Birthplace: Perry Co.
Mother Maiden Name: Elizabeth GAYHEART
Mother Birthplace: Knott Co., Ky.
Informant: Ray GRIGSBY, (illegible)
Burial Place: Vest
Date: 10 November 1942
Signature of funeral director: Engles, Hazard, Ky.
Date received by local registrar: 31 December 1942
Registrar's Signature: (illegible)
Date of Death: 09 November 1942
I hereby certify that I attended deceased from 07 November
1942 to (blank), that I
last saw him alive on (blank), and that death occurred on the date
stated above at 2:45 a.m.
Immediate cause of death: Cerebral hemorrhage
Due to: Hypertension heart disease
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: Chris S. Jackson, M.D., Hazard, Ky.
Date signed: 10 November 1942
Transcribed by Debbie Tamborski, 04 February 2010 |
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