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DEATH
CERTIFICATE
JULIS HALL
Date 03 September 1940
Cert: 21962
Place of Death: County: Knott City or Town:
Lackey, Ky.
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: Halo, Ky.
Full Name: Julis HALL
If Veteran Name War: (blank)
Social Security No.: 401-28-0580
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: 16 June 1923
Age: 17 years, 02 months, 18 days
Birthplace: Floyd Co.
Occupation: Miner
Industry or business: Inland Steel Co.
Father Name: Lenoard HALL
Father Birthplace: Knott Co.
Mother Maiden Name: Ida MARTIN
Mother Birthplace: Knott Co.
Informant/Address: Lenard HALL, Halo, Ky.
Burial Place: Halo, Ky.
Date: 04 September 1940
Signature of funeral director/address: G. D. Ryan, Martin, Ky.
Date received by local registrar: 30 September 1940
Registrar's Signature: Macie Miller
Date of Death: 03 September 1940
I hereby certify that I attended deceased from 02 September
1940 to
03 September 1940, that I last saw him alive on 03 September
1940, and that death occurred on the date stated above at 5:00
p.m.
Immediate cause of death: Titnus [sic] puncture wound of
(illegible ?face?) from rusty nail
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: Dr. W. L. Stumbo, M.D.
Date signed: (blank)
Transcribed by Debbie Tamborski, 18 August 2010 |
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