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DEATH
CERTIFICATE
JERRIE WAYNE HALL
Date 30 October 1940
Cert: 26569
Place of Death: County: Knott City or Town:
Lackey
Name of Hospital or Institution: Stumbo Memorial Hospital
Length of stay in hospital or community: (blank)
Usual Residence of Deceased: State: Ky. County:
Floyd
City or Town: Wayland, Ky.
Full Name: Jerrie WAYNE HALL
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: 24 February 1940
Age: 08 months, 06 days
Birthplace: Lackey, Ky.
Occupation: (blank)
Industry or business: (blank)
Father Name: John H. HALL
Father Birthplace: VA
Mother Maiden Name: Nora ISAC
Mother Birthplace: Pike Co.
Informant/Address: John H. HALL, Wayland, Ky.
Burial Place: Virgie, Ky.
Date: 31 October 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 25 November 1940
Registrar's Signature: Macie Miller
Date of Death: 30 October 1940
I hereby certify that I attended deceased from 29 October 1940 to
30 October 1940, that I last saw him alive on 30 October 1940, and that death
occurred on the date stated above at 2:15 a.m.
Immediate cause of death: Double Pneumonia
Duration: (blank)
Due to: (blank)
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: W. L. Stumbo, M.D., Lackey, Ky.
Date signed: (blank)
Transcribed by Debbie Tamborski, 18 August 2010 |
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