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DEATH
CERTIFICATE
JOE GRIGSBY
Date 22 October 1918
Cert: 26615
Place of Death: Vot. Precinct: 4C, Lynch Mines, Harlan Co.,
Ky.
Full Name: Joe GRIGSBY
Sex, Color or Race, Marital Status: Male, White, Married
Date of Birth: (marked out)
Age: 30 years
Occupation: Miner--ran machine
Birthplace: Knot Co., Ky.
Name of Father: Bill GRIGSBY
Birthplace Father: Ky.
Maiden name of Mother: (blank)
Birthplace Mother: (blank)
Informant/Address: W. E. Riley, Lynch Mines, Ky.
Filed: 20 October 1918
Registrar: J. M. Huff
Death Date: 22 October 1918
I hereby certify that I attended deceased from 20 October 1918, to
22 October 1928, that I last saw him alive on 22 October 1918, and that death
occurred, on the date stated above, at 1 p.m.
Cause of Death: Pneumonia
Duration: (blank)
Contributory: Flu
Duration: 02 days
Signed/Address: W. E. Riley, M.D., 23
October 1918, Lynch Mines, Ky.
Where was disease contracted: McRoberts, Ky.
Former or usual residence: McRoberts, Ky.
Place of Burial or Removal: (blank)
Date of Burial: (blank)
Undertaker/Address: (blank)
Transcribed by Debbie Tamborski, 28 February 2010 |
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